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It is best to limit protein intake at the end of diabetic nephropathy

2017-08-17 14:43

Diabetic nephropathy is a complication that prevents diabetic patients and is one of the most serious complications of diabetes. It causes microvascular complications due to hyperglycemia in diabetics and leads to glomerulosclerosis. Therefore, it is also called diabetic nephropathy in order to distinguish it from other nephropathy.

Diabetic nephropathy is divided into five stages

Early diabetic nephropathy shows enlargement of renal volume, glomerular filtration rate increased, a high filtration state, after the gradual emergence of gap proteinuria or albuminuria, with no control of the situation, with the extension of duration of persistent proteinuria, edema, hypertension, glomerular filtration rate decreased, resulting in renal disease if not timely treatment, or organ transplantation, very easily lead to death.

In order to better prevention and control of diabetic nephropathy, the clinical symptoms of diabetic nephropathy will be divided into five stages, making it easier for people to judge the diagnosis and stages of diabetic nephropathy, control, intervention and treatment in a timely manner. Here are five diagnostic criteria for staging of diabetic nephropathy:

Stage I: increased renal volume and increased glomerular filtration rate (GFR > 90 ml/ (min.1.73m2)) without clinical symptoms.

Stage II: normal albuminuria phase: rapid microalbuminuria, ACR < 30, ug/gCr, GFR, 60~89ml/ (min.1.73m2); normal blood pressure.

Stage III: early diabetic nephropathy: ACR, 30~300, ug/gCr, GFR30~59ml/ (min.1.73m2); slight elevation of blood pressure.

IV period: the advent of diabetic nephropathy: massive proteinuria, ACR, 300ug/gCr, >0.5g/24h urinary protein, GFR15~29ml/ (min.1.73m2);

Stage V: advanced diabetic nephropathy: GFR<10, ml/ (min.1.73m2), uremia.

Chronic high protein diet aggravates kidney burden

According to a survey, about 40~50% of diabetic patients will eventually develop kidney disease, which can rapidly develop into uremia in a few years and will have to rely on kidney replacement therapy. In western developed countries, half of diabetic nephropathy can change into uremia.

Studies have shown that in early diabetic nephropathy, the presence of glomerular hemodynamic changes is manifested by increased glomerular filtration rate, plasma flow, filtration fraction, and capillary pressure. In particular, increased glomerular capillary pressure is considered to be the most important cause of glomerular damage.

Therefore, dietary care for diabetic nephropathy currently advocates that protein intake should be limited in the early stage. Because a high protein diet for a long time may aggravate the high filtration state of the kidneys, while increasing the production and retention of toxic nitrogen metabolites in the body, leading to further damage to renal function. Therefore, we advocate limiting the amount of protein in the diet to reduce kidney damage.

Experiments have shown that after a rich protein diet, 2 to 3h, GFR can increase by 40%. In patients with diabetic nephropathy, the renal reserve function is significantly reduced, so a large number of protein diet can significantly increase the burden on the kidneys, and accelerate the development of kidney damage. In a model of diabetes induced by STZ, the control protein diet significantly slows kidney damage and reduces proteinuria.

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