The course of renal disease
Diabetic kidney disease develops over the years. Extensive studies in animals and humans have shown that the progression of various chronic kidney diseases, including nephropathy diabetic mainly due to secondary hemodynamic and metabolic disorders, not the activity of the underlying disease.
In some patients in the early years of diabetes, kidney filtration capacity is higher than in healthy individuals.
After several years of diabetes may occur in a small amount of urine albumin. This is the first stage of chronic kidney disease, which is characterized by microalbuminuria. At this stage it is preserved kidney filtration ability.
As the disease progresses, more albumin in the urine is due. This stage is called macroalbuminuria or proteinuria. How to increase the amount of albumin in the urine, thereby reducing renal filtration ability. With decreasing filtration ability more and more waste products of protein metabolism in the body reserves. With the development of renal impairment, there was an increase in blood pressure.
Impairment of renal function rarely occurs in the first 10 years of diabetes and usually take 15-25 years to the appearance of renal impairment. The risk of developing renal disease was lower in patients with diabetes live longer than 25 years without signs of renal impairment.
Diagnosis of CKD
In people with diabetes should be conducted regularly screened for kidney disease. Two key indicators of kidney disease are pGFR and albumin in the urine.
• pGFR. pGFR the estimated glomerular filtration rate. Each kidney contains about the billion tiny filters that are composed of blood vessels. These filters are called glomeruli. Renal function can be examined by the assessment of the amount of blood filtered by the glomeruli in one minute.Calculating pGFR based on the determination of creatinine in a blood sample. The higher the value of creatinine in the blood, the lower the value pGFR.
Renal disease is present when pGFR less than 60 milliliters per minute.
According to a physician diabetologist and nephrologist in patients with diabetes mellitus pGFR be determined from the serum creatinine at least once a year.
• albumin in the urine. Albumin in the urine is determined by comparing the amounts of albumin to the amount of creatinine in a single urine sample. When it comes to healthy kidneys urine will contain large amounts of creatinine, albumin and almost nothing. Even a minimal increase in the proportion of albumin in relation to creatinine is a sign of kidney damage.
Renal disease is present when the urine contains more than 30 milligrams of albumin per gram of creatinine, with or without reducing pGFR.
According to the recommendations of diabetologists and nephrologists at least once a year to determine the excretion of albumin in the urine of patients with type 2 diabetes and in patients with type 1 diabetes also need to do every 5 years to evaluate kidney damage.
The effects of high blood pressure
Elevated blood pressure or hypertension is a key factor in the development of kidney damage in people with diabetes. A family history of hypertension and the presence of hypertension in patients increases the risk of developing kidney disease. Hypertension also accelerates the progress of kidney disease when it is already present.
Arterial pressure is expressed using two numerical values. The first figure is the systolic pressure and represents the pressure in the arteries during cardiac contraction. The second value is the value of diastolic pressure and represents the pressure between the two cardiac contraction. It is common to hypertension defined as permanently elevated blood pressure greater than 140/90 mmHg.
According to the latest recommendations of the ideal blood pressure for people with diabetes is less than or equal to 130/80 mmHg.
Hypertension is not always the cause of kidney disease, it may be the result of kidney damage caused due to diabetes. With progression of renal disease in the kidney, changes occur that cause an increase in blood pressure. Early detection and treatment of even mild hypertension is of crucial importance for people with diabetes.
Prevention and slowing renal disease
Medications to reduce the pressure
Thanks to the work of scientists has made a significant progress in the development of methods by which it is possible to postpone the onset and slow the progression of kidney disease in people with diabetes. Medicines used to reduce blood pressure can significantly slow the progression of kidney disease. Demonstrated the effectiveness of two classes of drugs in slowing progression of renal disease.These are the angiotensin-converting (ACE-I) and angiotensin receptor blockers (ARB's). In many patients, a combination of two or more drugs to achieve adequate pressurization. With ACE-I and ARB-e can be used and diuretics, and drugs such as beta blockers, calcium channel blockers and other antihypertensives.
An example of an effective ACE and Lisinopril is often used in the treatment of diabetic kidney disease.With the effect of reducing blood pressure lisinopril has a direct protective effect on renal glomeruli. It has been shown that ACE and reduce proteinuria and slow down kidney damage in diabetic patients who did not have hypertension.
An example of an effective ARB is losartan, that has been shown to act protectively on renal function and reduces the risk of cardiovascular complications.
Any drug that helps to achieve target blood pressure levels or less jednako130/80 mmHg has a positive effect. Each patient even with mild hypertension or microalbuminuria should consult a doctor about the introduction of antihypertensive drugs in therapy.
A child deficient in protein
Excessive intake of protein may be harmful for diabetics. As recommended by dietitians with advanced diabetic kidney disease should not take sufficient amounts of protein, but definitely avoid foods with high protein content. In patients with significantly impaired renal function, a diet with reduced protein content can help delay the occurrence of renal failure. Adherence restricted diet protein requires consultation with the dietitian to ensure adequate nutrition.
Intensive control of blood sugar levels
Antihypertensive medications and a diet with low protein content may slow the development of CKD.The third measure that has shown promise for diabetics, especially those who present with early-stage CKD, intensive control of blood sugar levels.
The human body converts food into glucose, a simple sugar that is the main energy source for the body's cells. To enter the station to help glucose insulin, a hormone produced by the pancreas. When the body does not produce enough insulin, or absent response to the insulin that is present, the body can not use glucose, and it builds up in the bloodstream. The diagnosis of diabetes is made based on high levels of glucose in the blood. Intensive control of blood glucose levels is aiming to maintain normal blood glucose levels. Regime often includes controlling blood glucose, insulin delivery during the day depending on food intake and physical activity, adherence to the child, appropriate level of physical activity and regular consultation of the medical team. Some patients using insulin pump of insulin throughout the day.
Numerous studies have pointed to the positive effects of intensive control of blood glucose levels. In one study noted the delay in emergence and slow progression of early diabetic kidney disease in 50% of patients who adhered to the intensive regime for the control of blood glucose levels. Patients who adhered to an intensive regime had average blood glucose 8.3 mmol / l, which is about 4.4 mmol / l lower than the levels recorded in patients treated with the standard method. Good glycemic control reduces the risk of early-stage renal disease by a third. Numerous RESEARCH conducted over the last few decades have made it clear that any program that the end result of a decrease in the blood glucose level has a positive effect in patients with early-stage CKD.
Dialysis and transplantation
When the diabetic patients develop end-stage renal failure in the account comes dialysis or a kidney transplant. Back in the 1970s, diabetics often are not offered this method of treatment because it was believed that the damage caused by the diabetes undo the positive effects of treatment. Today, thanks to better control of diabetes and poboljšnom survival, doctors are reluctant to offer diabetic dialysis and kidney transplantation as a treatment method.
There kidney transplant survival for people with diabetes about the same survival rate for kidney transplants to people without the disease. Dialysis is also a good method of treatment for diabetics, but in the short term. Diabetics with kidney transplant or who are treated with dialysis have higher rates of morbidity and mortality due to complications associated with diabetes such as damage to the heart, eyes and nerves.
Good care makes a difference
People with diabetes should:
• determine the level of A1C at least twice a year. The test shows the average blood glucose levels over the previous three months. The target value is less than 7%;
• Work with your doctor about the inzulna injections, medications, meal planning, physical activity, and monitoring blood glucose levels;
• Check blood pressure several times a year or even a month if blood pressure are not well regulated. If the high pressure values should follow the instructions of your doctor to achieve normal values. The target pressure value is less than or equal to 130/80 mmHg;
• Consult with your doctor about the possible benefits of ACE-I and ARBs;
• determine pGFR at least once a year to assess renal function;
• determine the level of protein in the urine at least once a year to assess kidney damage, consult with your doctor or dietitian about the need to reduce the intake of protein food.
Remember
Diabetes is the leading cause of CKD and kidney failure.
Diabetics should regularly perform screening for kidney disease. The two key markers for kidney disease are pGFR and albuminuria.
Medicines used to reduce the pressure can significantly slow the progression of kidney disease. Two groups of drugs, ACE-I and ARBs, and proved to be effective in slowing progression of renal disease.
Excessive intake of protein may be harmful for diabetics.
Intensive control of blood glucose levels is very important for diabetics, especially those with already developed at early stages of CKD.
Conclusion
Number of people with diabetes is increasing. Consequently, an increasing number of people with diabetic kidney disease. According to the predictions of some experts diabetes could soon become the cause of 50% of chronic liver damage. In light of the more common illnesses and deaths associated with diabetes and renal disease, patients, researchers, and health professionals must continue to work towards improving the final outcome of these patients.
Diabetic kidney disease develops over the years. Extensive studies in animals and humans have shown that the progression of various chronic kidney diseases, including nephropathy diabetic mainly due to secondary hemodynamic and metabolic disorders, not the activity of the underlying disease.
In some patients in the early years of diabetes, kidney filtration capacity is higher than in healthy individuals.
After several years of diabetes may occur in a small amount of urine albumin. This is the first stage of chronic kidney disease, which is characterized by microalbuminuria. At this stage it is preserved kidney filtration ability.
As the disease progresses, more albumin in the urine is due. This stage is called macroalbuminuria or proteinuria. How to increase the amount of albumin in the urine, thereby reducing renal filtration ability. With decreasing filtration ability more and more waste products of protein metabolism in the body reserves. With the development of renal impairment, there was an increase in blood pressure.
Impairment of renal function rarely occurs in the first 10 years of diabetes and usually take 15-25 years to the appearance of renal impairment. The risk of developing renal disease was lower in patients with diabetes live longer than 25 years without signs of renal impairment.
Diagnosis of CKD
In people with diabetes should be conducted regularly screened for kidney disease. Two key indicators of kidney disease are pGFR and albumin in the urine.
• pGFR. pGFR the estimated glomerular filtration rate. Each kidney contains about the billion tiny filters that are composed of blood vessels. These filters are called glomeruli. Renal function can be examined by the assessment of the amount of blood filtered by the glomeruli in one minute.Calculating pGFR based on the determination of creatinine in a blood sample. The higher the value of creatinine in the blood, the lower the value pGFR.
Renal disease is present when pGFR less than 60 milliliters per minute.
According to a physician diabetologist and nephrologist in patients with diabetes mellitus pGFR be determined from the serum creatinine at least once a year.
• albumin in the urine. Albumin in the urine is determined by comparing the amounts of albumin to the amount of creatinine in a single urine sample. When it comes to healthy kidneys urine will contain large amounts of creatinine, albumin and almost nothing. Even a minimal increase in the proportion of albumin in relation to creatinine is a sign of kidney damage.
Renal disease is present when the urine contains more than 30 milligrams of albumin per gram of creatinine, with or without reducing pGFR.
According to the recommendations of diabetologists and nephrologists at least once a year to determine the excretion of albumin in the urine of patients with type 2 diabetes and in patients with type 1 diabetes also need to do every 5 years to evaluate kidney damage.
The effects of high blood pressure
Elevated blood pressure or hypertension is a key factor in the development of kidney damage in people with diabetes. A family history of hypertension and the presence of hypertension in patients increases the risk of developing kidney disease. Hypertension also accelerates the progress of kidney disease when it is already present.
Arterial pressure is expressed using two numerical values. The first figure is the systolic pressure and represents the pressure in the arteries during cardiac contraction. The second value is the value of diastolic pressure and represents the pressure between the two cardiac contraction. It is common to hypertension defined as permanently elevated blood pressure greater than 140/90 mmHg.
According to the latest recommendations of the ideal blood pressure for people with diabetes is less than or equal to 130/80 mmHg.
Hypertension is not always the cause of kidney disease, it may be the result of kidney damage caused due to diabetes. With progression of renal disease in the kidney, changes occur that cause an increase in blood pressure. Early detection and treatment of even mild hypertension is of crucial importance for people with diabetes.
Prevention and slowing renal disease
Medications to reduce the pressure
Thanks to the work of scientists has made a significant progress in the development of methods by which it is possible to postpone the onset and slow the progression of kidney disease in people with diabetes. Medicines used to reduce blood pressure can significantly slow the progression of kidney disease. Demonstrated the effectiveness of two classes of drugs in slowing progression of renal disease.These are the angiotensin-converting (ACE-I) and angiotensin receptor blockers (ARB's). In many patients, a combination of two or more drugs to achieve adequate pressurization. With ACE-I and ARB-e can be used and diuretics, and drugs such as beta blockers, calcium channel blockers and other antihypertensives.
An example of an effective ACE and Lisinopril is often used in the treatment of diabetic kidney disease.With the effect of reducing blood pressure lisinopril has a direct protective effect on renal glomeruli. It has been shown that ACE and reduce proteinuria and slow down kidney damage in diabetic patients who did not have hypertension.
An example of an effective ARB is losartan, that has been shown to act protectively on renal function and reduces the risk of cardiovascular complications.
Any drug that helps to achieve target blood pressure levels or less jednako130/80 mmHg has a positive effect. Each patient even with mild hypertension or microalbuminuria should consult a doctor about the introduction of antihypertensive drugs in therapy.
A child deficient in protein
Excessive intake of protein may be harmful for diabetics. As recommended by dietitians with advanced diabetic kidney disease should not take sufficient amounts of protein, but definitely avoid foods with high protein content. In patients with significantly impaired renal function, a diet with reduced protein content can help delay the occurrence of renal failure. Adherence restricted diet protein requires consultation with the dietitian to ensure adequate nutrition.
Intensive control of blood sugar levels
Antihypertensive medications and a diet with low protein content may slow the development of CKD.The third measure that has shown promise for diabetics, especially those who present with early-stage CKD, intensive control of blood sugar levels.
The human body converts food into glucose, a simple sugar that is the main energy source for the body's cells. To enter the station to help glucose insulin, a hormone produced by the pancreas. When the body does not produce enough insulin, or absent response to the insulin that is present, the body can not use glucose, and it builds up in the bloodstream. The diagnosis of diabetes is made based on high levels of glucose in the blood. Intensive control of blood glucose levels is aiming to maintain normal blood glucose levels. Regime often includes controlling blood glucose, insulin delivery during the day depending on food intake and physical activity, adherence to the child, appropriate level of physical activity and regular consultation of the medical team. Some patients using insulin pump of insulin throughout the day.
Numerous studies have pointed to the positive effects of intensive control of blood glucose levels. In one study noted the delay in emergence and slow progression of early diabetic kidney disease in 50% of patients who adhered to the intensive regime for the control of blood glucose levels. Patients who adhered to an intensive regime had average blood glucose 8.3 mmol / l, which is about 4.4 mmol / l lower than the levels recorded in patients treated with the standard method. Good glycemic control reduces the risk of early-stage renal disease by a third. Numerous RESEARCH conducted over the last few decades have made it clear that any program that the end result of a decrease in the blood glucose level has a positive effect in patients with early-stage CKD.
Dialysis and transplantation
When the diabetic patients develop end-stage renal failure in the account comes dialysis or a kidney transplant. Back in the 1970s, diabetics often are not offered this method of treatment because it was believed that the damage caused by the diabetes undo the positive effects of treatment. Today, thanks to better control of diabetes and poboljšnom survival, doctors are reluctant to offer diabetic dialysis and kidney transplantation as a treatment method.
There kidney transplant survival for people with diabetes about the same survival rate for kidney transplants to people without the disease. Dialysis is also a good method of treatment for diabetics, but in the short term. Diabetics with kidney transplant or who are treated with dialysis have higher rates of morbidity and mortality due to complications associated with diabetes such as damage to the heart, eyes and nerves.
Good care makes a difference
People with diabetes should:
• determine the level of A1C at least twice a year. The test shows the average blood glucose levels over the previous three months. The target value is less than 7%;
• Work with your doctor about the inzulna injections, medications, meal planning, physical activity, and monitoring blood glucose levels;
• Check blood pressure several times a year or even a month if blood pressure are not well regulated. If the high pressure values should follow the instructions of your doctor to achieve normal values. The target pressure value is less than or equal to 130/80 mmHg;
• Consult with your doctor about the possible benefits of ACE-I and ARBs;
• determine pGFR at least once a year to assess renal function;
• determine the level of protein in the urine at least once a year to assess kidney damage, consult with your doctor or dietitian about the need to reduce the intake of protein food.
Remember
Diabetes is the leading cause of CKD and kidney failure.
Diabetics should regularly perform screening for kidney disease. The two key markers for kidney disease are pGFR and albuminuria.
Medicines used to reduce the pressure can significantly slow the progression of kidney disease. Two groups of drugs, ACE-I and ARBs, and proved to be effective in slowing progression of renal disease.
Excessive intake of protein may be harmful for diabetics.
Intensive control of blood glucose levels is very important for diabetics, especially those with already developed at early stages of CKD.
Conclusion
Number of people with diabetes is increasing. Consequently, an increasing number of people with diabetic kidney disease. According to the predictions of some experts diabetes could soon become the cause of 50% of chronic liver damage. In light of the more common illnesses and deaths associated with diabetes and renal disease, patients, researchers, and health professionals must continue to work towards improving the final outcome of these patients.
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