1 minute self-test, 5 small questions about the diagnosis and treatment of diabetic nephropathy (3) | Clear the "Secret" language

Edited by Yimaitong, please do not reprint without authorization.

 Challenge yourself and accumulate knowledge.

What, another exam? NO! This is just a playoff game.

The Endocrinology Department of Yimaitong has set up a column of "Passing Customs' Secret Language", which aims to help everyone consolidate or update endocrine-related knowledge in a relaxed and pleasant learning atmosphere.

Each issue contains about 5 multiple-choice questions.
The content is mainly based on authoritative guides/consensus at home and abroad.
References will be marked in the analysis part for everyone to review and review.

 The content of this quiz is based on the "Chinese Guidelines for Clinical Diagnosis and Treatment of Diabetic Kidney Disease" published in the Chinese Journal of Nephrology in March this year.
Get ready and let's answer the questions together.

 Multiple choice questions 1.
Kidney biopsy can avoid misdiagnosis or missed diagnosis of DKD and/or NDKD, but which of the following are contraindications for DKD kidney biopsy? A: There is obvious bleeding tendency B: Mental disorder C: Diabetes is too long Click on the blank space below to get the answer (slideable) Answer: A, B Analysis: The contraindications of DKD kidney biopsy are similar to other kidney diseases.

➤When the patient has obvious bleeding tendency, mental disorder cannot cooperate, isolated kidney, etc.
, kidney biopsy should be avoided to prevent the increase of complications.

➤Relative contraindications include: uncontrolled hypertension, aneurysm and other renal anatomy abnormalities, application of anticoagulant drugs, pregnancy, urinary system infection, etc.

➤In addition, patients with serum creatinine greater than 176.
8umol/L have an increased risk of bleeding.
It is recommended that for such patients, the necessity of renal biopsy must be fully evaluated, and the benefits and risks must be weighed to determine whether to perform renal biopsy. Multiple choice question 2.
In which of the following situations, a kidney biopsy can be considered (no contraindications)? A: A history of DM <5 years, a large amount of proteinuria or renal insufficiency.
B: A rapid decrease in eGFR of unknown cause or a decrease of more than 30% in 3 months after ACEI/ARB treatment.
C: A large amount of proteinuria but no DR.
Click the blank space below Get the answer (slideable) Answer: A, B, C Analysis: Kidney biopsy is of great value for the diagnosis of DKD.

However, the indications of DKD kidney biopsy have not yet reached a unified consensus at home and abroad.

The "Guide" of this Ministry recommends that under the premise of no contraindications to renal biopsy, patients with the following conditions may consider renal biopsy.

 1.
A history of DM <5 years with massive proteinuria or renal insufficiency.

(A) 2.
A large amount of proteinuria or nephrotic syndrome appears in a short period of time.

(A) 3.
Urine sediment indicates "active" glomerular hematuria.

(B) 4.
Unexplained rapid decline in eGFR or eGFR decline by more than 30% within 3 months after ACEI/ARB treatment.

(B) 5.
A lot of proteinuria but no DR.

(A) 6.
Intractable hypertension.

(C) 7.
Have clinical symptoms, signs or laboratory tests of systemic diseases.

(А) 8.
If pathological grading or disease evaluation of DKD is needed, kidney biopsy can be considered as appropriate.

(B) Multiple choice question 3.
For patients in DKD-CKD G1~2, what is the recommended daily protein intake? A: 0.
8 g/kg B: 0.
6 g/kg C: 1.
0~1.
2 g/kg Click on the blank space below to get the answer (slideable) Answer: A Analysis: Limiting protein intake is an important treatment for patients with DKD, aiming to help the body Maintain a relatively good nutritional status, while reducing the accumulation of excessive waste in the patient's body, and alleviating the symptoms of uremia as much as possible.

The guidelines recommend a protein intake of 0.
8 g/kg/d for DKD-CKD G1~2. Multiple choice question 4.
For DKD-CKD G3~5 patients (non-dialysis), what is the recommended daily protein intake? A: 0.
8 g/kg B: 0.
6 g/kg C: 1.
0~1.
2 g/kg Click on the blank space below to get the answer (slideable) Answer: B Analysis: Limiting protein intake is an important treatment for DKD patients, aimed at helping the body Maintain a relatively good nutritional status, while reducing the accumulation of excessive waste in the patient's body, and alleviating the symptoms of uremia as much as possible.

The guideline recommends that the protein intake of DKD-CKD G3~5 (non-dialysis) patients is 0.
6g/kg/d, and supplementation of compound alpha keto acid therapy is also recommended.

Multiple choice question 5.
What is the recommended daily protein intake for patients undergoing dialysis in DKD-CKD G5? A: 0.
8 g/kg B: 0.
6 g/kg C: 1.
0~1.
2 g/kg Click on the blank space below to get the answer (slideable) Answer: C Analysis: Limiting protein intake is an important treatment for patients with DKD, aiming to help the body Maintain a relatively good nutritional status, while reducing the accumulation of excessive waste in the patient's body, and alleviating the symptoms of uremia as much as possible.

The guidelines recommend that the protein intake of DKD-CKD G5 dialysis patients is 1.
0~1.
2 g/kg/d.

Reference: Expert Group of Chinese Medical Association Nephrology Branch.
Chinese Guidelines for Clinical Diagnosis and Treatment of Diabetic Nephropathy[J].
Chinese Journal of Nephrology, 2021, 37(3): 255-304.