Health Guidance for Patients with Diabetic Nephropathy

Diabetic nephropathy is a diabetic microvascular disease, which is common in diabetic patients with a course of more than 10 years. It is the most common cause of end-stage renal disease and one of the main causes of death from diabetes. According to epidemiological investigation, about 30% of type 1 diabetes and 20% to 50% of type 2 diabetes may develop diabetic nephropathy. With the increase of age and course of disease, the prevalence of diabetic nephropathy gradually increases. The disease course is 20 years as the peak of the disease, and it can eventually develop into end-stage renal disease. Once it develops into end-stage renal disease, 2/3 people need dialysis and 1/3 people need kidney transplantation. Therefore, it brings great burden and pressure to patients and families. As World Nephropathy Day is approaching, our journal invites experts to talk about diabetic nephropathy related knowledge.

The exact pathogenesis of diabetic nephropathy is not yet fully understood. Existing studies have revealed that diabetic nephropathy is the result of kidney damage caused by multiple reasons. Changes in hemodynamics are the key factor in its occurrence, and may even be the initiating factor. . Under the action of long-term hyperglycemia, renal capillary blood pressure and blood flow increase, and capillary permeability increases and proteinuria occurs. In addition, patients with diabetic nephropathy produce a large amount of oxygen free radicals in their bodies, which can cause serious damage to the patients’ kidneys; inflammatory factors are also closely related to the occurrence and progression of the disease.

Current status of diabetic kidney disease in my country

There are “two highs and three lows” in diabetic nephropathy in my country. “Two highs” refer to high prevalence and great harm, and “three lows” refer to low awareness rates, low treatment rates and low control rates.

1. High prevalence

my country is currently conducting a national epidemiological survey of diabetic nephropathy, but the results have not yet been released.

Inferred from previous literature, the proportion of diabetic nephropathy in my country is 30%-40%. And since 2011, the proportion of diabetic nephropathy in chronic kidney disease has surpassed that of glomerulonephritis-related nephropathy, and the gap is increasing. This seems to indicate that the proportion of diabetic patients with complications of diabetic nephropathy is increasing.

2. Great harm

Diabetic nephropathy is not only an important cause of end-stage renal disease, but also greatly increases the risk of cardiovascular disease and the risk of all-cause death in patients with type 2 diabetes. In general, once it develops into diabetic nephropathy, it will seriously affect the patient’s quality of life, increase the economic burden, and even shorten the life of the patient.

3. Low awareness rate

At present, there is no relevant research data revealing the awareness rate of diabetic nephropathy in the Chinese population, and foreign data can be used as a reference. Studies have shown that the screening rate for stage 1 to 3 diabetic nephropathy is less than 20%, and the awareness rate of diabetic nephropathy is about 17.8%. Due to the level of screening rates for diabetic nephropathy abroad, the awareness rate of diabetic nephropathy among the diabetic population in my country will not be too high.

4. Low treatment rate

The treatment of diabetic nephropathy emphasizes early comprehensive management (based on lifestyle intervention, combined with lowering blood sugar, lowering blood pressure, and regulating blood lipids) and conventional treatment with angiotensin converting enzyme inhibitors/angiotensin receptor blockers recommended by domestic and foreign guidelines method. Once diabetic nephropathy develops, conventional treatments have very limited curative effects. It is difficult to reverse in the middle and late stages and can only be treated symptomatically.

5. Low control rate

The current situation of diabetic nephropathy control in my country is not optimistic. Research shows that through comprehensive analysis of blood glucose, blood pressure, blood lipids and other indicators, the comprehensive treatment standard rate of diabetic nephropathy patients in my country is only 3.6%. Among them, only 36.0% of patients had glycosylated hemoglobin <7%, only 20.8% of patients had blood pressure <130/80 mmHg, and only 36.1% of patients had low-density lipoprotein cholesterol <2.6 mmol/L. Diabetic nephropathy belongs to traditional medicine Diabetic nephropathy belongs to the category of "diabetes" in traditional medicine. Although there is no clear record in ancient Chinese medicine books, related descriptions can be seen in medical books such as "Suwen·Pathogenesis and Qibao Ming Ji", "Sanji General Record" and other medical books , Such as "diarrhea for a long time, kidney qi injury, kidney governs water, kidney qi is weak, urine is sweet, there is ointment". Moreover, according to its clinical manifestations, it is often considered to be in the categories of "edema", "turbid urine", and "Guange". Professor Lu Renhe named diabetic nephropathy as "diabetic nephropathy" based on years of experience. Some scholars also classified diabetic nephropathy as "diabetic nephropathy". "Spleen spleen nephropathy" and "elimination spleen nephropathy". Traditional Chinese medicine believes that the occurrence of diabetic nephropathy is mostly related to insufficient congenital endowment, eating disorder, emotional imbalance or loss of labor, resulting in yin fluid loss, excessive dryness and heat, and the pathogenesis is based on deficiency and excess, which is responsible for the lungs and stomach As well as the kidney, the original deficiency is the deficiency of qi (lung qi deficiency, spleen qi deficiency) and yin (kidney yin deficiency deficiency), and dry heat and blood stasis are the criteria. In the early stage of the disease, kidney yin deficiency is more common; yin deficiency consumes qi over time, resulting in kidney qi and yin deficiency; later yin damage and yang, yin and yang deficiency injures the heart and spleen, spleen and kidney yang deficiency, unable to transport water and valley essence, water and fluid retention In the late stage, it can be seen that the kidney yang is decayed, the turbidity is internally stopped, the blood is not smooth, the blood is stasis, and the blood is stasis. Chinese and Western medicine treatment of diabetic nephropathy 1. Western medicine treatment 1. Control blood sugar Hyperglycemia damages the kidneys throughout the diabetic nephropathy. Studies have shown that good blood sugar control is reversible for the early pathological changes of diabetes. It can reduce the increased glomerular filtration rate, shrink the enlarged kidney, and reduce microalbuminuria. Blood sugar control can be treated with diabetes education, diet and exercise regulation, and drugs (oral hypoglycemic drugs that do not aggravate kidney damage, insulin). 2. Control blood pressure Although blood pressure is not a cause of diabetes, it can accelerate the progression and deterioration of diabetes. Antihypertensive therapy can reduce proteinuria and delay the decline of glomerular filtration rate in the early stage of diabetes. At present, the drugs commonly used in the treatment of diabetes mellitus include angiotensin converting enzyme inhibitors, angiotensin receptor blockers and calcium ion antagonists. 3. Lower blood lipids Cholesterol is mainly increased, and statins can be used. In addition to indirectly protecting the kidneys by lowering blood lipids, statins can also affect the proliferation of mesangial cells and the proliferation of mesangial matrix, as well as the inflammation and fibrosis of the renal tubulointerstitium, which have an important impact on the progression of kidney disease. Mainly triacylglycerol, fibric acid drugs can be used. 4. Low protein diet A high-protein diet can increase the blood flow and pressure of the glomerulus, and aggravate the changes in renal hemodynamics caused by hyperglycemia. Once proteinuria occurs, the patient's daily protein intake should be restricted. 5. Improve high blood viscosity Take a small dose of aspirin under the guidance of a physician. 6. Guanidine complex Some guanidine complexes (aminoguanidine) are more active than the lysine e amino group in proteins, and form an inactive substance with early glycosylated proteins, instead of the formation of advanced glycosylation end products, and prevent advanced glycosylation end products The accumulation on the blood vessel wall simultaneously inhibits the effects of aldose reductase and nitric oxide synthase. 2. TCM treatment 1. Chinese patent medicine The main components of Tangmaikang are Astragalus, Shengdi, Salvia, Achyranthes, Rehmannia glutinosa, Mulberry Leaf, Red Peony Root, Coptis, Polygonatum, Pueraria, Epimedium. It has the effects of nourishing yin and clearing heat, replenishing qi and strengthening the kidney, promoting blood circulation and removing stasis. Modern studies have shown that Tangmaikang has the effects of improving blood circulation, reducing blood viscosity, improving red blood cell deformability, improving plasmin activity, anti-platelet aggregation, and scavenging free radicals in the body. Therefore, Tangmaikang can improve the microcirculation in the glomerulus, reduce the pressure in the glomerulus, scavenge free radicals, improve the deformability of red blood cells, reduce the permeability of the capillary in the glomerulus and reduce the excretion of proteinuria through the above-mentioned mechanism. Tangmaikang is used for early diabetic nephropathy: (1) Improvement of Cystatin C Cystatin C is an early sensitive indicator of kidney damage. (2) Improvement of microalbuminuria Microalbuminuria is an early clinical manifestation of diabetic nephropathy. Early diagnosis and early treatment can reverse the disease or delay its progress. 2. Chinese medicine Astragalus, Codonopsis, Chinese yam, Cornus officinalis, Radix Rehmanniae, Moutan Bark, Poria and Alisma can be used in combination to reduce blood pressure and blood lipids in patients with diabetic nephropathy, treat patients with diabetic nephropathy, and achieve the purpose of improving kidney function. This is mainly because Astragalus contains a large amount of polysaccharides and saponins, which can accelerate lipid metabolism and increase the plasma protein level of patients with diabetic nephropathy; Codonopsis can increase the dilatation of peripheral blood vessels, thereby lowering the patient’s blood pressure and alleviating insulin resistance. In addition, studies have also found that Chinese yam and dogwood can reduce blood lipids in diabetic patients and enhance their immunity; Rehmannia glutinosa can significantly lower blood pressure and blood viscosity; Moutan bark, Poria and Alisma can promote diuresis and lower blood pressure Blood lipids, improve immunity. 3. Chinese medicine injection The treatment of diabetic nephropathy with traditional Chinese medicine injection is mainly based on the basic ideas of smoothing blood vessels, removing blood stasis, and replenishing qi and nourishing yin in the theory of traditional Chinese medicine. In recent years, it has been used in the treatment of diabetic nephropathy. 4. Acupuncture Acupuncture is the essence of ancient Chinese medicine. It is based on the theory of yin and yang reconciling meridians and has a unified and dialectical idea. Acupuncture and moxibustion have a very good effect on the treatment of many diseases, and it has been widely recognized worldwide. Acupuncture and moxibustion can also exert certain effects on diabetic nephropathy. In recent years, scholars have reported that acupuncture Shenshu (located on the waist, under the spinous process of the second lumbar vertebra, 1.5 cun lateral to the side), Pishu (located on the back, under the spinous process of the eleventh thoracic vertebra, 1.5 cun lateral to the side) ), Zusanli (located on the anterolateral side of the lower leg, depressed on the outer side of the patellar ligament, 3 inches below the Dubi acupoint, and a transverse finger on the lateral side of the anterior tibial crest), Yinlingquan (located on the inner side of the lower leg, in the depression below the medial tibial condyle), Qu Chi acupoint (the elbow is bent at a right angle, and the midpoint of the line connecting the lateral end of the elbow transverse crease with the lateral epicondyle of the humerus), Zhigou acupoint (located in the posterior area of ​​the forearm, 3 cun above the transverse crease of the dorsal wrist, midway between the ulna and the radius), Hegu acupoint (Located between the first and second metacarpal bones on the back of the hand, at the midpoint of the radial side of the second metacarpal bone), Sanyinjiao (located on the inner side of the lower leg, 3 cun above the tip of the medial malleolus, as the posterior edge of the inner side of the tibia), Zhongwan (located on the upper Abdomen, anterior midline, 4 inches above the umbilicus), Zhongji point (located on the lower abdomen, anterior midline, 4 inches below the umbilicus), Taichong point (located on the dorsal side of the foot, when the junction of the first and second metatarsals Back depression), Tianshu (located on the abdomen, 2 inches from the center of the umbilical cord), Gaoling (located on the back, below the spinous process of the fourth thoracic vertebra, 3 inches from the posterior midline), Fenglong (located in front of the calf) Lateral, when the tip of the lateral malleolus is 8 inches above the tip of the lateral malleolus, 1 inch beyond the mouth of the mouth, and the two transverse fingers on the lateral side of the anterior tibial crest), the Diji point (located on the inner side of the calf, 3 inches below the Yinling Spring, when the tip of the medial malleolus connects with Yinling Spring) (Top) and Baihuanshu (located in the sacrum, under the spinous process of the fourth sacral vertebra, 1.5 inches laterally, about leveling the fourth posterior foramen) and other points, can achieve the purpose of strengthening the spleen and kidney, and alleviating the symptoms of diabetes. In addition, acupuncture therapy is often used in combination with some traditional diabetic nephropathy treatment drugs, and has achieved some good results. In recent years, Chinese medicine has made certain progress in the treatment of diabetic nephropathy, which can effectively alleviate the development of the patient's condition, and has small adverse reactions, relatively safe, and very promising. Link: Home care for patients with diabetic nephropathy Eating less carbohydrates and reducing protein intake in the diet can not only reduce the burden of kidney disease, but also slow down the progression of diabetic nephropathy. Eat more vegetables and fruits to keep your stool smooth. In daily life, patients need to perform appropriate exercises, such as walking, playing Tai Chi, practicing Baduan Jin, etc., with slight sweating as the standard. The water temperature of the patient should not be too high when bathing and washing feet in daily life to prevent burns. Because the existence of diabetic neuropathy makes the body's sense of temperature dull, too high water temperature can easily lead to burns. Prohibit smoking, limit alcohol consumption, and maintain a normal weight. If there is edema and high blood pressure, water and salt intake should be restricted. If you have anemia, you can choose iron-rich foods, such as red dates. If kidney failure occurs, you should try to eat less foods with high potassium, such as tomatoes, spinach, and bananas, so as not to increase blood potassium. For long-term bedridden patients, turn over frequently, scrub frequently, and maintain skin hygiene. And often massage the compressed parts to promote blood circulation, so as to prevent local blood from being blocked and pressure sores. Actively prevent infections, including urinary tract infections, skin infections, and digestive tract infections. Diet porridge for patients with diabetic nephropathy Diabetic nephropathy mostly has kidney damage, and patients will continue to lose a large amount of protein from urination. The following introduces two dietary prescriptions for diabetic nephropathy patients. Astragalus porridge 30-60 grams of raw astragalus, 60 grams of japonica rice, 10 grams of dried tangerine peel. Decoction the astragalus decoction to remove the residue, then add the japonica rice to cook the porridge, and add the tangerine peel after the porridge is finished. Improve kidney function, eliminate proteinuria, and enhance physical fitness. Wolfberry porridge 30 grams of wolfberry and 50 grams of japonica rice. The two things are cooked into porridge and eaten in the morning and evening. It has the functions of invigorating the kidney and spleen and eliminating proteinuria.