Why does diabetes affect the kidneys? How to avoid diabetic nephropathy? What treatments are available?
It’s almost October, and many companies and units have started the annual physical examination time. Many friends looked at the red letter in the report and asked: What should I do if my blood sugar is high? … The doctor said that I was already diabetic and had microalbuminuria. In order to avoid nephropathy, they asked me to take medicine and take insulin. Is there any problem? …
Here, there are some suggestions for the treatment of diabetes and the delay of complications such as nephropathy, which can be shared with you!
Avoiding diabetic nephropathy, the choice of treatment
In fact, in general, for diabetes, hyperglycemia and other problems, there are already more effective treatment procedures, mainly to control blood sugar to avoid complications.
The first-line treatment of diabetes should be based on the patient’s condition, such as age, chronic disease, blood sugar level, etc., to adjust the living habits and diet. If the patient is more serious, it may be necessary to use metformin and other drugs to control blood sugar.
Some friends ask, are there any side effects of taking metformin for a long time? According to current research, metformin can effectively control sugar and reduce the risk of cardiovascular disease. For some obese patients, it can also reduce weight. The side effects are small, and the main side effect may be the adverse reactions of the gastrointestinal tract and affect the appetite.
In addition, if patients with severely reduced kidney function, they cannot take it, which may cause lactic acidosis. However, this does not mean that metformin will damage the kidneys, but when the renal function is severely damaged, the excretion of drugs and lactic acid will be hindered, resulting in the accumulation of lactic acid. Generally speaking, it is best to avoid the glomerular filtration rate <30ml/min. taken.
After the first-line drug is used, if the patient’s blood sugar is still poorly controlled, the second-line treatment should be considered. The first choice is insulin. If the glycated hemoglobin is high, other hypoglycemic drugs may be needed. At this stage, the complications of the patient should be considered, such as cardiovascular and cerebrovascular diseases, myocardial infarction, nephropathy, retinopathy, etc., depending on the patient. Organs that need to be protected to select appropriate hypoglycemic agents.
So for the prevention of nephropathy, people with diabetes can consider choosing SGLT-2 inhibitors, which are called sodium-glucose cotransporter 2 inhibitors in Chinese. Liejing and empagliflozin, why do these drugs protect the kidneys? Let’s talk about the principle of diabetic nephropathy first.
What is the principle of diabetic nephropathy?
Diabetic nephropathy involves many changes at the molecular level, which may not be detailed here. This time, we will only talk about the principle of the disease in a general direction.
There are hundreds of thousands of glomeruli in the kidney. The glomerulus is the main executor of the kidney to filter water. Once there is a problem with the glomerulus, the basic function of the kidney will be challenged. Diabetic nephropathy is the accumulation of long-term high blood sugar. The resulting diseases, generally speaking, there is a problem with the glomerulus, and it takes about ten years to detect microalbuminuria. That is to say, if the patient has microproteinuria when he or she is diagnosed with diabetes, it means that he is in hyperglycemia. Status has been around for almost 10 years.
Long-term high blood sugar in diabetic patients will affect the microvascular, which will increase the glomerular microvascular blood flow, increase the pressure, and increase the glomerular filtration rate, but this does not mean that the renal function is increased. Rather, it is a morbid upfront reaction. In this case, the renal vascular pressure is always high, the glomeruli will increase, fibrosis and sclerosis will occur, and finally the glomeruli will lose their function. When the number reaches a certain level, the renal function begins to decline significantly, and proteinuria occurs. On the other hand, the products of blood glucose metabolism will also affect the kidneys.
According to the above principles, the development of diabetic nephropathy will go through 5 stages:
During the high filtration period, the filtration rate of the kidneys will increase, and the kidneys may become larger.
During the silent period, the renal filtration rate remains at the highest point, which may last for several years.
During the microalbuminuria stage, the renal filtration rate begins to decline, and microalbuminuria appears in the urine at the same time.
In the stage of massive proteinuria, with the filtration rate dropping significantly, the proteinuria is also more serious.
End-stage renal disease. At this time, the renal disease is already serious and the patient needs dialysis or kidney transplantation.
The longer one has diabetes, the higher the risk of kidney disease, which is more likely if the patient also has high blood pressure, mainly because high blood pressure can exacerbate glomerular damage.
As far as treatment is concerned, it is best for most patients to control the disease before the third stage. At this stage, the disease may be reversed, or the deterioration of the disease may be delayed. Therefore, once diabetes is diagnosed, it is best to conduct a urine test in time. If any protein is found. Urine, then it is best to do relevant examinations to determine the condition and prevent it in advance.
How to prevent diabetic nephropathy
The first is to control blood sugar. Daily diet is a key consideration. In addition to regulating blood pressure, the current antihypertensive drugs that protect kidney function are mainly ACEI (angiotensin-converting enzyme inhibitor), ARBS (angiotensin receptor) blockers), i.e. pril and sartans.
Then there are the drugs that control sugar and protect the kidney, SGLT2 inhibitors, and Liejing.
This type of drug mainly controls the reabsorption of sugar by the kidney. Normal people filter through the glomerulus every day, and the renal tubule absorbs about 160 grams of sugar, and SGLT2 inhibitors can inhibit this reabsorption process. In this case , sugar can be excreted through the urine to achieve the effect of lowering blood sugar. However, the side effect is prone to urinary tract infections.
Heart and kidney protection
In addition to lowering blood sugar, Liejing drugs also have the effect of protecting the kidneys and protecting the heart, which can reduce related complications.
A 2015-2017 study in the New England Journal of Medicine found that empagliflozin could reduce cardiovascular disease by 14%, cardiac death by 38%, heart failure hospitalizations by 35%, and diabetes by 39%. Risk of worsening nephropathy. Since then, studies in many countries have found that lecithin drugs, including empagliflozin, dapagliflozin, canagliflozin, etc. have good research results, especially the protective effect on the kidneys is very obvious, so currently listed As a new generation of hypoglycemic drugs, net drugs can be used to delay the deterioration of renal function and protect the kidneys.
References:
Zinman，Bernard，et al.“Empagliflozin，cardiovascular outcomes，and mortality in type 2 diabetes.”New England Journal of Medicine 373.22（2015）：2117-2128.
Wanner，Christoph，et al.“Empagliflozin and progression of kidney disease in type 2 diabetes.”New England Journal of Medicine 375.4（2016）：323-334.
Neal，Bruce，et al.“Canagliflozin and cardiovascular and renal events in type 2 diabetes.”New England Journal of Medicine377.7（2017）：644-657