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Author: Dr Li Qing TEDA Tianjin University Hospital Diabetic nephropathy is a common complication of diabetes, according to statistics, about one-third of people with diabetes will occur in diabetic nephropathy.
Generally speaking, if you have a history of diabetes for more than 5 years, if your urine microprotein-creatinine ratio exceeds the standard for more than 2 times, it is considered to be diabetic nephropathy.
In the early stage of diabetic nephropathy, the patient may not feel obvious, there is no foam in the urine, and even the urine protein in the routine urine test is negative, but the urine microprotein creatinine ratio exceeds the standard.
However, if the following signals appear, it means that diabetic nephropathy has worsened.
1.
Dominant proteinuria or massive proteinuria In early diabetic nephropathy, the glomerular filtration membrane is slightly damaged, and small-molecule microalbumin "leaks" into the urine through the damaged filtration membrane.
As the condition worsens, the filter membrane is severely damaged, and more protein or even a large amount of protein "leaks" into the urine to form dominant proteinuria or a large amount of proteinuria.
At this time, foam may appear in the urine, and the urine protein (+) in routine urine test often exceeds 0.
3g/d.
The more "+" urine protein, or the greater the urine protein quantitative, the more serious the condition.
2.
Edema A large amount of protein in the blood is lost from the urine, causing hypoalbuminemia over time.
When the plasma albumin is lower than 30g/L, edema will appear.
Edema often occurs in low-lying areas such as the lower legs, and bedridden people can also occur in the hips and thighs.
Especially severe hypoproteinemia, and sodium and water retention after renal function declines, eyelid and facial edema may also occur.
3.
Hypertension Diabetics are considered high blood pressure if their blood pressure is ≥130/80mmHg.
After the occurrence of diabetic nephropathy, the renal excretion of sodium decreases and sodium and water retention; at the same time, the damaged kidney secretes a substance called renin, which activates the renin-angiotensin-aldosterone system to cause vasoconstriction.
Sodium retention and renin secretion can cause high blood pressure.
If a diabetic person develops high blood pressure, or the original high blood pressure is higher and more difficult to control, it means that the diabetic nephropathy condition is aggravated.
Fourth, the urine output changes.
Normal adults generally do not urinate at night.
If they habitually wake up more than 2 times every night, or the night urine volume exceeds 1/3 of the total urine volume in a day, it is said that nocturia is increased.
Nocturia is often a manifestation of renal tubular damage.
Severe renal function decline, decreased sodium excretion and drainage capacity of the kidneys, decreased urine output (less than 700ml per day), oliguria (less than 400ml per day) or even anuria (less than 150ml per day) .
5.
Elevated blood creatinine Blood creatinine is a metabolic waste of protein, which is mainly excreted from the body through the kidneys.
Generally speaking, the amount of blood creatinine produced every day is relatively fixed, and normal kidneys can always adjust blood creatinine within the normal range.
If the blood creatinine rises, it means that kidney function declines.
In the early stage of diabetes, blood creatinine may decrease slightly due to the hyperfiltration of the kidneys caused by blood sugar.
However, as the glomeruli are gradually destroyed, the filtering capacity of the kidneys gradually decreases, and the blood creatinine will gradually increase.
Elevated blood creatinine is not a signal of early kidney disease, but a signal of severe kidney disease.
6.
Anemia The hemoglobin of adult males is less than 120g/L, and the hemoglobin of adult females (non-pregnant) is less than 110g/L, which means anemia.
Normal kidneys secrete erythropoietin to promote the production of red blood cells.
After renal function is impaired, erythropoietin secretion is reduced, and anemia will occur, which is called renal anemia, which is manifested as chlorosis, pale conjunctiva, and pale and dull lips.
Generally speaking, renal anemia does not appear until the glomerular filtration rate is less than 60ml/min.
Therefore, anemia is not a signal of early kidney damage, but a signal of severe kidney disease, and the severity of anemia is often the same as the degree of renal dysfunction.
7.
Vitamin D with low blood calcium and high blood phosphorus does not become active until processed by the kidneys. After renal function is impaired, active VD is lacking, calcium absorption is impaired, and the loss increases, and a series of problems such as low calcium, high phosphorus, and osteoporosis will appear.
In clinical practice, it is often seen that some elderly people have broken bones without receiving much external force.
This may be a "pathological fracture" caused by renal failure first and calcium deficiency osteoporosis later.
8.
Kidney Atrophy The normal kidney is 10cm long, the cortex is 1.
5cm thick, and the size on both sides is the same.
If the kidney color Doppler ultrasound finds that the length of the kidney is less than 9 cm, or the renal cortex is less than 1 cm, it means that the kidney is atrophy.
9.
Gastrointestinal Symptoms After renal function declines, metabolic wastes are discharged less and accumulate in the body, causing metabolic acidosis, which stimulates the gastrointestinal mucosa to appear nausea, vomiting, loss of appetite, chronic diarrhea and other gastrointestinal symptoms.
10.
Skin itching After renal dysfunction, phosphorus excretion is impaired, and it is deposited under the skin to cause itching of the skin.
In severe cases, the itching of the skin is unbearable, and the scratched skin is full of scars and it is difficult to resolve.
In a word, the following phenomena of diabetic nephropathy indicate that diabetic nephropathy is aggravated: oedema of the eyelids and face, oedema of the feet and ankles; fatigue and lack of energy; increased nocturia; increased blood pressure; foam in the urine ➤Nausea, vomiting, decreased appetite; ➤Pale complexion and nail bed; ➤Smelling urine in the breath; ➤Itchy skin.
Source: Popularization of Kidney Diseases
Generally speaking, if you have a history of diabetes for more than 5 years, if your urine microprotein-creatinine ratio exceeds the standard for more than 2 times, it is considered to be diabetic nephropathy.
In the early stage of diabetic nephropathy, the patient may not feel obvious, there is no foam in the urine, and even the urine protein in the routine urine test is negative, but the urine microprotein creatinine ratio exceeds the standard.
However, if the following signals appear, it means that diabetic nephropathy has worsened.
1.
Dominant proteinuria or massive proteinuria In early diabetic nephropathy, the glomerular filtration membrane is slightly damaged, and small-molecule microalbumin "leaks" into the urine through the damaged filtration membrane.
As the condition worsens, the filter membrane is severely damaged, and more protein or even a large amount of protein "leaks" into the urine to form dominant proteinuria or a large amount of proteinuria.
At this time, foam may appear in the urine, and the urine protein (+) in routine urine test often exceeds 0.
3g/d.
The more "+" urine protein, or the greater the urine protein quantitative, the more serious the condition.
2.
Edema A large amount of protein in the blood is lost from the urine, causing hypoalbuminemia over time.
When the plasma albumin is lower than 30g/L, edema will appear.
Edema often occurs in low-lying areas such as the lower legs, and bedridden people can also occur in the hips and thighs.
Especially severe hypoproteinemia, and sodium and water retention after renal function declines, eyelid and facial edema may also occur.
3.
Hypertension Diabetics are considered high blood pressure if their blood pressure is ≥130/80mmHg.
After the occurrence of diabetic nephropathy, the renal excretion of sodium decreases and sodium and water retention; at the same time, the damaged kidney secretes a substance called renin, which activates the renin-angiotensin-aldosterone system to cause vasoconstriction.
Sodium retention and renin secretion can cause high blood pressure.
If a diabetic person develops high blood pressure, or the original high blood pressure is higher and more difficult to control, it means that the diabetic nephropathy condition is aggravated.
Fourth, the urine output changes.
Normal adults generally do not urinate at night.
If they habitually wake up more than 2 times every night, or the night urine volume exceeds 1/3 of the total urine volume in a day, it is said that nocturia is increased.
Nocturia is often a manifestation of renal tubular damage.
Severe renal function decline, decreased sodium excretion and drainage capacity of the kidneys, decreased urine output (less than 700ml per day), oliguria (less than 400ml per day) or even anuria (less than 150ml per day) .
5.
Elevated blood creatinine Blood creatinine is a metabolic waste of protein, which is mainly excreted from the body through the kidneys.
Generally speaking, the amount of blood creatinine produced every day is relatively fixed, and normal kidneys can always adjust blood creatinine within the normal range.
If the blood creatinine rises, it means that kidney function declines.
In the early stage of diabetes, blood creatinine may decrease slightly due to the hyperfiltration of the kidneys caused by blood sugar.
However, as the glomeruli are gradually destroyed, the filtering capacity of the kidneys gradually decreases, and the blood creatinine will gradually increase.
Elevated blood creatinine is not a signal of early kidney disease, but a signal of severe kidney disease.
6.
Anemia The hemoglobin of adult males is less than 120g/L, and the hemoglobin of adult females (non-pregnant) is less than 110g/L, which means anemia.
Normal kidneys secrete erythropoietin to promote the production of red blood cells.
After renal function is impaired, erythropoietin secretion is reduced, and anemia will occur, which is called renal anemia, which is manifested as chlorosis, pale conjunctiva, and pale and dull lips.
Generally speaking, renal anemia does not appear until the glomerular filtration rate is less than 60ml/min.
Therefore, anemia is not a signal of early kidney damage, but a signal of severe kidney disease, and the severity of anemia is often the same as the degree of renal dysfunction.
7.
Vitamin D with low blood calcium and high blood phosphorus does not become active until processed by the kidneys. After renal function is impaired, active VD is lacking, calcium absorption is impaired, and the loss increases, and a series of problems such as low calcium, high phosphorus, and osteoporosis will appear.
In clinical practice, it is often seen that some elderly people have broken bones without receiving much external force.
This may be a "pathological fracture" caused by renal failure first and calcium deficiency osteoporosis later.
8.
Kidney Atrophy The normal kidney is 10cm long, the cortex is 1.
5cm thick, and the size on both sides is the same.
If the kidney color Doppler ultrasound finds that the length of the kidney is less than 9 cm, or the renal cortex is less than 1 cm, it means that the kidney is atrophy.
9.
Gastrointestinal Symptoms After renal function declines, metabolic wastes are discharged less and accumulate in the body, causing metabolic acidosis, which stimulates the gastrointestinal mucosa to appear nausea, vomiting, loss of appetite, chronic diarrhea and other gastrointestinal symptoms.
10.
Skin itching After renal dysfunction, phosphorus excretion is impaired, and it is deposited under the skin to cause itching of the skin.
In severe cases, the itching of the skin is unbearable, and the scratched skin is full of scars and it is difficult to resolve.
In a word, the following phenomena of diabetic nephropathy indicate that diabetic nephropathy is aggravated: oedema of the eyelids and face, oedema of the feet and ankles; fatigue and lack of energy; increased nocturia; increased blood pressure; foam in the urine ➤Nausea, vomiting, decreased appetite; ➤Pale complexion and nail bed; ➤Smelling urine in the breath; ➤Itchy skin.
Source: Popularization of Kidney Diseases
