Diabetes mellitus is a disease accompanied by a constant increase in blood glucose. Despite the fact that glucose is used by our body as a source of energy, in excessive quantities it begins to have a toxic effect on tissue and organs, causing their damage. Glucose is binded to cell proteins and other molecules, which is why small and large blood vessels are damaged over time, tissue nutrition worsens, but the kidney damage in diabetes can be prevented. As a result, the work of vital organs is violated, late complications of diabetes are developing.
Diabetic nephropathy is a specific damage to the blood vessels of diabetes, which in severe cases can lead to the development of renal failure that requires replacement renal therapy - a state where the kidneys cannot perform their function. One of the most important functions of the kidneys is the elimination of the urine of substances that are formed as a result of the vital activity of the body and have toxic effects, and the retention of substances necessary for the body. That is, the kidneys perform the filter in the body.
One of the substances necessary for the body is protein, which is normal, the kidneys are delayed and prevented it from entering the urine. However, with diabetes mellitus due to damage to the vascular wall, protein enters urine. The appearance of protein in the urine is an important symptom of nephropathy. Albumin is a protein whose molecules have a small diameter. Albumin is the earliest sign of kidney problems in diabetes. Healthy buds pass a very small amount of it into urine. As soon as their work worsens a little - there is more albumin in the urine. Therefore, patients with diabetes mellitus must at least 1 time a year take urine analysis to determine the protein (microalbumin) in it even with good health and lack of complaints.
The progression of changes in the blood vessels of the kidneys leads to the fact that the kidneys cease to remove water and other, sometimes toxic substances, symptoms of severe kidney function - swelling, increased blood pressure, decrease in the amount of urine, shortness of breath appear. With the development of the terminal stage of renal failure, the patient needs hemodialysis (blood cleansing procedure using an artificial kidney apparatus) or kidney transplantation.
However, damage to the kidneys in diabetes can be warned.
The prevention of development and progression of diabetic nephropathy includes:
1. The regular control of the level of glucose in the blood and maintaining its level in the target for this patient.
2. Control of blood pressure, achievement and maintenance of targeted blood pressure indicators (less than 130/80 mm Hg).
3. Control of the level of blood lipids (total cholesterol and its fractions), if necessary, prescribing drugs to normalize the level of lipids.
4. Control of body weight, weight loss with its excess or obesity (by 5-10% for 3-6 months).
5. Smoking from smoking.
6. Salt consumption (less than 3 g per day).
7. When edema, ensuring the control of fluid consumed.
8. If necessary, the constant use of nephroprotective and diuretics.
9. Out of the intake of nephrotoxic drugs.
- Treatment of anemia (hemoglobin target values for women - 115-150 g/l, for men - 120-160 g/l).
- Correction of mineral and bone disorders.
- If necessary, an endocrinologist can direct the patient to a consultation with a nefrolist in the presence of indications (rapid progression of renal failure, difficulty in choosing treatment tactics and a number of others).
Endocrinologist of the Minsk City Clinical Endocrinological Center A.I. Kozlov
