Diuretics for diabetic nephropathy. Diabetic nephropathy: symptoms, stages and treatment. Lower respiratory tract damage

Infectious complications in patients with “sweet disease” are very common. It is necessary to quickly begin active antimicrobial therapy for the timely elimination of the pathological focus. Many patients are interested in what antibiotics are available for diabetes.

It is immediately necessary to clarify that this group of medications should be taken only under the supervision of the attending physician and with his prescription. alters the normal metabolic process. In most cases, the effect of the drug may differ from that of a relatively healthy body.

Few people know about such nuances. Therefore, unwanted side reactions often appear after using antimicrobial agents for “sweet illnesses.”

Antibiotics and diabetes

Before using medications directly, it is necessary to study all the risks that may await the patient when using the drugs.

These include:

1. Decompensated course of the disease.
2. Elderly age.
3. Already formed late ones (micro- and macroangiopathy, retinopathy, nephro- and neuropathy).
4. Duration of the disease (˃10 years).
5. The presence of changes in the functioning of some components of the immune system and the entire body as a whole (reduced activity of neutrophils, phagocytosis and chemotaxis).

When the doctor takes into account all these aspects, he will be able to more accurately determine the drug needed for the patient and prevent a number of undesirable consequences.

Also, we must not forget about the following important points:

1. Different antibiotics for diabetes mellitus have different effects on the effectiveness of hypoglycemic medications (and tablets that reduce serum glucose). Thus, sulfonamides and macrolides inhibit enzymes that are responsible for the breakdown of active substances of drugs. As a result, more active compounds enter the blood, and the effect and duration of their work increases. Rifampicin, on the contrary, inhibits the quality of the effects of hypoglycemic drugs.
2. Microangiopathy leads to sclerosis of small vessels. Therefore, it is advisable to start antibiotic therapy with intravenous injections, and not with injections into the muscles, as usual. Only after saturating the body with the required dose can you switch to oral forms of medication.

When to use antibiotics?

Microorganisms can potentially affect almost all areas of the body.

Most often affected:

• Urinary system;
• Skin;
• Lower respiratory tract.

Urinary tract infections (UTIs) are caused by the formation of nephropathy. The kidney barrier does not cope with its function 100% and bacteria actively attack the structures of this system.

Examples of UTIs:

• Abscess of perirenal adipose tissue;
• Pyelonephritis;
• Papillary necrosis;
• Cystitis.

Antibiotics for diabetes mellitus in this case are attributed to the following principles:

1. The drug must have a broad spectrum of action for initial empirical therapy. Until the exact pathogen is identified, cephalosporins and fluoroquinolones are used.
2. The duration of treatment for complex forms of UTI is approximately 2 times longer than usual. Cystitis – 7-8 days, pyelonephritis – 3 weeks.
3. If the patient's nephropathy progresses, it is necessary to constantly monitor the excretory function of the kidneys. To do this, creatinine clearance and glomerular filtration rate are regularly measured.
4. If there is no effect from the antibiotic used, you need to change it.

Skin and soft tissue infections

This type of damage most often manifests itself as:

• Furunculosis;
• Carbuncle;
• Diabetic foot syndrome;
• Fasciitis.

First of all, to eliminate symptoms, it is necessary to normalize glycemia. It is elevated blood sugar that causes the progression of the disease and slows down the process of soft tissue regeneration.

Additional principles of therapy remain:

1. Ensuring complete rest and maximum unloading of the injured limb (if we are talking about a diabetic foot).
2. Use of powerful antimicrobial drugs. The most commonly prescribed drugs are 3rd generation cephalosporins, carbapenems, and protected penicillins. The choice of medication depends on the sensitivity of the pathogen and the individual characteristics of the patient. The duration of treatment is at least 14 days.
3. The use of surgical procedures (removal of dead tissue or drainage of purulent lesions).
4. Continuous monitoring of vital functions. If the process actively spreads, there may be a question of limb removal.

Respiratory tract infections

Antibiotics for patients with concomitant pneumonia or bronchitis are prescribed according to the standard scheme of a unified clinical protocol. You should start with protected penicillins (Amoxiclav), then depending on the situation. It is important to constantly monitor the condition of the lungs with x-rays. Additional symptomatic therapy is used.

Prescribing antibacterial drugs for diabetes mellitus requires great attention and care from the doctor. Since microbes always actively attack the human body with a “sweet disease,” it is worth thinking about using a variety of probiotics and medications that prevent the death of one’s own microflora.

With this approach, it will be possible to neutralize the side effects of most aggressive drugs.

Against the background of weak compensation of diabetes mellitus, 10-20% of patients develop a dangerous complication - diabetic nephropathy (ICD 10 code - N08.3). Due to damage to small and large vessels, many organs suffer, including the kidneys. Bilateral damage to natural filters disrupts the functioning of the excretory system, provokes stagnation, and worsens the course of endocrine pathology.

Who is at risk? What symptoms indicate the development of a dangerous complication? How to restore the functioning of the bean-shaped organs? How to prevent kidney damage in diabetes? The answers are in the article.

Causes

A slowly progressive complication, against the background of which chronic renal failure develops, is more often detected in men, people with a long history of diabetes, and adolescents with. Without treatment, death can occur.

There are several theories for the development of diabetic nephropathy:

• hemodynamic. The main factor is intraglomerular hypertension, a violation of blood flow in the structures of the bean-shaped organs. At the first stage of the pathological process, increased accumulation of urine was noted, but over time the connective tissue grows, the kidneys significantly reduce fluid filtration;
• metabolic. Against the background of persistence, negative changes occur during metabolic processes: the toxic effect of increased concentration appears, glycated proteins are formed, and the level of fat increases. Against the background of capillary damage, the glomeruli and other elements of the bean-shaped organs experience excessive stress and gradually lose functionality;
• genetic. The main cause of DN is the influence of factors programmed at the genetic level. Against the background of diabetes, metabolism is disrupted and changes occur in blood vessels.

Risk group:

• patients with diabetes experience of 15 years or more;
• teenagers with ;
• persons diagnosed with insulin-dependent diabetes mellitus.

Provoking factors:

• persistent arterial hypertension, especially with irregular use of drugs that stabilize blood pressure;
• infectious lesion of the genitourinary area;
• smoking;
• taking medications that negatively affect the kidney structures;
• male gender;
• poor diabetes compensation, uncontrolled hyperglycemia for a long time.

First signs and symptoms

A characteristic feature of diabetic nephropathy is the gradual development of negative signs and slow progression of pathology. In most cases, kidney damage affects patients with 15-20 years of diabetes experience. Provoking factors: fluctuations in glucose levels, frequent excess of normal levels, lack of discipline of the patient, insufficient control of sugar levels.

Stages of diabetic nephropathy:

• asymptomatic. Absence of a pronounced clinical picture. Tests show an increase in glomerular filtration; microalbumin in the urine does not reach 30 mg per day. In some patients, ultrasound will reveal hypertrophy of the bean-shaped organs, increased blood flow in the kidneys;
• the second stage is the beginning of structural changes. The condition of the renal glomeruli is disrupted, increased fluid filtration and urine accumulation persist, tests show a limited amount of protein;
• the third stage is prenephrotic. The concentration of microalbumin increases (from 30 to 300 mg per day), proteinuria rarely develops, and surges in blood pressure occur. Most often, glomerular filtration and blood flow velocity are normal or deviations are minor;
• fourth stage. Persistent proteinuria, tests show the constant presence of protein in urine. Periodically, hyaline casts and blood appear in the urine. Persistent arterial hypertension, tissue swelling, abnormal blood counts. The transcript of the analysis indicated an increase in cholesterol, ESR, beta and alpha globulins. Urea levels and creatinine levels change slightly;
• fifth, the most difficult stage. With persistent uremia and the development of nephrosclerosis, the concentration and filtration capacity of the bean-shaped organs sharply decreases, and azothermia develops. Blood protein is below normal, swelling increases. Specific test results: the presence of protein, casts, blood in the urine, sugar in the urine is not determined. In diabetics, blood pressure increases significantly: up to 170-190 or more (upper) by 100-120 mm Hg. Art. (bottom). A specific feature of the nephrosclerotic stage is a decrease in insulin loss in the urine, a decrease in the need for exogenous production of the hormone and glucose concentration, and the risk. At the fifth stage of diabetic nephropathy, a dangerous complication develops - renal failure (chronic type).

Note! Scientists believe that diabetic nephropathy develops through the interaction of factors from three categories. It is difficult to break the vicious circle if there is insufficient control of sugar levels: the negative impact of all mechanisms is manifested, which leads to chronic renal failure and serious disorders of the general condition.

Diagnostics

Early detection of kidney damage in diabetes helps maintain the stability of excretory function and the patient’s life. The asymptomatic course of diabetic nephropathy complicates diagnosis, but there is a simple way to reduce the risk of dangerous consequences - regular health monitoring. It is important to periodically donate blood and urine, undergo an ultrasound examination of the kidneys and abdominal organs.

When the first signs of DN appear, the patient should undergo an in-depth examination:

• urine and blood analysis (general and biochemical);
• Rehberg and Zimnitsky test;
• performing ultrasound and Dopplerography of renal vessels;
• clarification of albumin level in urine;
• bacterial culture of urine;
• examination of the organs of the excretory system using ultrasound;
• excretory urography;
• determining the ratio of indicators such as creatinine and albumin in the morning portion of urine;
• aspiration biopsy of renal tissue with the rapid development of nephrotic syndrome.

It is important to differentiate DN from severe lesions of the bean-shaped organs. Specific signs are similar to manifestations of kidney tuberculosis, indolent form of pyelonephritis, glomerulonephritis. If diabetic nephropathy is confirmed, albumin excretion exceeds 300 mg per day or a large amount of protein is detected in the urine. In the severe stage of DN, the level of phosphates, lipids, calcium, urea and creatinine in the urine is significantly increased, and massive proteinuria develops.

General rules and effective tagging

Detection of any amount of protein in the urine is a reason for an in-depth examination and initiation of therapy. It is important to stabilize kidney function before critically extensive areas of fibrosis develop.

Main goals of therapy:

• protect natural filters from the influence of negative factors in the background;
• lower blood pressure, reduce the load on the kidney vessels;
• restore the functionality of the bean-shaped organs.

When microalbuminuria (protein in the urine) is detected, complex treatment ensures the reversibility of pathological processes and returns indicators to optimal values. Proper implementation of therapy restores the storage, filtration, and excretory functions of natural filters.

To stabilize blood pressure, a diabetic takes a set of medications:

• combination of ACE inhibitors with angiotensin receptor blockers;
• diuretics to remove excess water and sodium, reduce swelling;
• beta blockers. The drugs lower blood pressure and blood volume with each contraction of the heart muscle and reduce heart rate;
• calcium channel blockers. The main purpose of drugs is to facilitate blood flow through the renal vessels;
• As prescribed by your doctor, you need to take blood thinners: Cardiomagnyl, Aspirin Cardio. It is important to follow the daily dosage, course duration, and treatment rules to avoid the risk of gastric bleeding.

• monitor sugar levels, take medications that normalize glucose levels, get optimal glucose levels. It is important to prevent hyperglycemia, against the background of which diabetic nephropathy develops;
• stop smoking and drinking alcohol;
• follow a low-carbohydrate diet, avoid frequent consumption of protein foods;
• perform exercises to prevent obesity and normalize the condition of blood vessels;
• be nervous less often;
• in agreement with the cardiologist, replace nephrotoxic drugs with more benign names;
• prevent high levels of cholesterol and triglycerides: eat less animal fats, take tablets to stabilize the lipid factor: Finofibrate, Lipodemin, Atorvastatin, Simvastatin;
• be sure to measure glucose levels throughout the day: in the later stages of diabetic nephropathy, hypoglycemia often develops.

Find out about the causes, as well as methods of treating the tumor.

The rules and features of using Metformin tablets for type 1 and type 2 diabetes are described on the page.

Important details:

• preventive measures are replaced by active therapeutic methods against the background of the development of the third stage of diabetic nephropathy. It is important to stabilize cholesterol levels and sharply reduce the intake of animal protein and salt. To normalize the functioning of the heart and blood vessels and treat arterial hypertension, ACE inhibitors and drugs that stabilize blood pressure are needed;
• if the patient began to be examined at stage 4 of DN, then it is important to follow a salt-free and low-protein diet, receive ACE inhibitors, and be sure to reduce the level of triglycerides and “bad” cholesterol using the drugs indicated above;
• in severe, fifth stage of DN, doctors supplement treatment measures with other types of therapy. The patient receives vitamin D3 to prevent osteoporosis and erythropoietin to optimize performance. The development of chronic renal failure is a reason for prescribing peritoneal blood purification, hemodialysis or kidney transplantation.

Prevention

This dangerous complication of diabetes develops less frequently if the patient follows the doctor’s recommendations and achieves a high degree of compensation for endocrine pathology. In types 1 and 2 diabetes, it is important to choose the optimal dose of insulin to avoid sharp fluctuations in glucose levels. It is important to regularly visit an endocrinologist and get tested to identify the initial stage of DN.

Periodic monitoring of urine and blood parameters allows timely detection of disturbances in the structure and blood flow in the kidneys. It is important to know: diabetic nephropathy in combination with arterial hypertension, abnormal metabolism, and sugar surges can lead to kidney failure.

Learn more about the features of treatment for severe complications of diabetes mellitus on the kidneys from the following video:

Diabetic nephropathy is the general name for most of the kidney complications of diabetes. This term describes diabetic lesions of the filtering elements of the kidneys (glomeruli and tubules), as well as the vessels that feed them.

Diabetic nephropathy is dangerous because it can lead to end-stage renal failure. In this case, the patient will need to undergo dialysis or.

Diabetic nephropathy is one of the common causes of early mortality and disability in patients. Diabetes is not the only cause of kidney problems. But among those undergoing dialysis and waiting in line for a donor kidney for transplantation, the majority of people are diabetic. One of the reasons for this is the significant increase in the incidence of type 2 diabetes.

Causes of development of diabetic nephropathy:

• elevated blood sugar levels in the patient;
• poor levels of cholesterol and triglycerides in the blood;
• high blood pressure (read our “sister” site on hypertension);
• anemia, even relatively “mild” (hemoglobin in the blood< 13,0 г/литр) ;
• smoking (!).

Symptoms of diabetic nephropathy

Diabetes can have a destructive effect on the kidneys for a very long time, up to 20 years, without causing any discomfort in the patient. Symptoms of diabetic nephropathy appear when kidney failure has already developed. If a patient develops symptoms, this means that metabolic waste is accumulating in the blood. Because the affected kidneys cannot cope with their filtration.

Stages of diabetic nephropathy. Tests and diagnostics

Almost all diabetics need annual tests to monitor their kidney function. If diabetic nephropathy develops, it is very important to detect it at an early stage, while the patient does not yet experience symptoms. The earlier treatment for diabetic nephropathy begins, the greater the chance of success, i.e., that the patient will be able to live without dialysis or a kidney transplant.

In 2000, the Ministry of Health of the Russian Federation approved the classification of diabetic nephropathy by stages. It included the following wording:

• stage of microalbuminuria;
• stage of proteinuria with preserved nitrogen excretion function of the kidneys;
• stage of chronic renal failure (dialysis treatment or).

Later, experts began to use a more detailed foreign classification of kidney complications of diabetes. It no longer distinguishes 3, but 5 stages of diabetic nephropathy. See more details. What stage of diabetic nephropathy a particular patient has depends on his glomerular filtration rate (how it is determined is described in detail). This is the most important indicator that shows how well your kidney function is preserved.

At the stage of diagnosing diabetic nephropathy, it is important for the doctor to understand whether kidney damage is caused by diabetes or other reasons. A differential diagnosis of diabetic nephropathy with other kidney diseases should be carried out:

• chronic pyelonephritis (infectious inflammation of the kidneys);
• kidney tuberculosis;
• acute and chronic glomerulonephritis.

Signs of chronic pyelonephritis:

• symptoms of body intoxication (weakness, thirst, nausea, vomiting, headache);
• pain in the lower back and abdomen on the side of the affected kidney;
• increased blood pressure;
• in ⅓ of patients - frequent, painful urination;
• tests show the presence of leukocytes and bacteria in the urine;
• characteristic picture on ultrasound of the kidneys.

Features of kidney tuberculosis:

• in the urine - leukocytes and mycobacterium tuberculosis;
• with excretory urography (x-ray of the kidneys with intravenous administration of a contrast agent) - a characteristic picture.

Diet for complications of diabetes on the kidneys

In many cases of diabetic kidney problems, limiting salt intake can help lower blood pressure, reduce swelling, and slow the progression of diabetic nephropathy. If your blood pressure is normal, then eat no more than 5-6 grams of salt per day. If you already have hypertension, then limit your salt intake to 2-3 grams per day.

Now the most important thing. Official medicine recommends a “balanced” diet for diabetes, and even lower protein intake for diabetic nephropathy. We suggest that you consider using a low-carbohydrate diet to effectively lower your blood sugar to normal. This can be done when the glomerular filtration rate is above 40-60 ml/min/1.73 m2. In the article “” this important topic is described in detail.

Treatment of diabetic nephropathy

The main way to prevent and treat diabetic nephropathy is to lower blood sugar, and then maintain it close to the norm for healthy people. Above you learned how this can be done using . If a patient's blood glucose level is chronically elevated or constantly fluctuates from high to hypoglycemia, all other measures will be of little use.

Medicines to treat diabetic nephropathy

To control arterial hypertension, as well as intraglomerular increased pressure in the kidneys, medications - ACE inhibitors - are often prescribed for diabetes. These drugs not only lower blood pressure, but also protect the kidneys and heart. Their use reduces the risk of end-stage renal failure. It is likely that long-acting ACE inhibitors work better than captopril, which must be taken 3-4 times a day.

If, as a result of taking a drug from the group of ACE inhibitors, a patient develops a dry cough, then the drug is replaced with an angiotensin-II receptor blocker. Drugs in this group are more expensive than ACE inhibitors, but they are much less likely to cause side effects. They protect the kidneys and heart with about the same effectiveness.

The target blood pressure level for people with diabetes is 130/80 or lower. Typically, in patients with type 2 diabetes, it can only be achieved using a combination of medications. It may consist of an ACE inhibitor and blood pressure medications from other groups: diuretics, beta blockers, calcium antagonists. ACE inhibitors and angiotensin receptor blockers are not recommended to be used together. You can read about combination medications for hypertension that are recommended for use in diabetes. The final decision on which pills to prescribe rests with the doctor.

How kidney problems affect diabetes treatment

If a patient is diagnosed with diabetic nephropathy, then the methods of treating diabetes change significantly. Because many medications need to be stopped or their dosage reduced. If the glomerular filtration rate decreases significantly, then insulin dosages should be reduced, because weak kidneys excrete it much more slowly.

Please note that the popular type 2 diabetes drug can only be used if the glomerular filtration rate is above 60 ml/min/1.73 m2. If a patient's kidney function is weakened, the risk of lactic acidosis, a very dangerous complication, increases. In such situations, metformin is discontinued.

If the patient’s tests show anemia, then it needs to be treated, and this will slow down the development of diabetic nephropathy. The patient is prescribed drugs that stimulate erythropoiesis, i.e., the production of red blood cells in the bone marrow. This not only reduces the risk of kidney failure, but also usually improves overall quality of life. If the diabetic is not yet on dialysis, he may also be prescribed iron supplements.

If preventive treatment for diabetic nephropathy does not help, kidney failure develops. In such a situation, the patient has to undergo dialysis, and if possible, then undergo a kidney transplant. On the issue of kidney transplantation, we have a separate one, and we will briefly discuss hemodialysis and peritoneal dialysis below.

Hemodialysis and peritoneal dialysis

During a hemodialysis procedure, a catheter is inserted into the patient's artery. It is connected to an external filtering device that purifies the blood instead of the kidneys. After purification, the blood is sent back into the patient's bloodstream. Hemodialysis can only be performed in a hospital setting. It can cause low blood pressure or infection.

Peritoneal dialysis is when a tube is inserted into the abdominal cavity rather than into an artery. Then a large amount of liquid is fed into it using the drop method. This is a special liquid that draws out waste. They are removed as the liquid drains from the cavity. Peritoneal dialysis must be performed every day. It carries a risk of infection where the tube enters the abdominal cavity.

In diabetes mellitus, fluid retention, nitrogen and electrolyte imbalances develop at higher glomerular filtration rates. It means that Diabetic patients should be transferred to dialysis earlier than patients with other renal pathologies. The choice of dialysis method depends on the preference of the doctor, but for patients there is not much difference.

When to start renal replacement therapy (dialysis or kidney transplantation) in patients with diabetes:

• Kidney glomerular filtration rate< 15 мл/мин/1,73 м2;
• Elevated levels of potassium in the blood (> 6.5 mmol/l), which cannot be reduced by conservative treatment methods;
• Severe fluid retention in the body with the risk of developing pulmonary edema;
• Obvious symptoms of protein-energy malnutrition.

Blood test targets for diabetic patients treated with dialysis:

• Glycated hemoglobin - less than 8%;
• Blood hemoglobin - 110-120 g/l;
• Parathyroid hormone – 150–300 pg/ml;
• Phosphorus – 1.13–1.78 mmol/l;
• Total calcium – 2.10–2.37 mmol/l;
• Product Ca × P = Less than 4.44 mmol2/l2.

Hemodialysis or peritoneal dialysis should be considered only as a temporary step in preparation for. After a kidney transplant, the patient is completely cured of renal failure while the graft is functioning. Diabetic nephropathy is stabilizing, patient survival is increasing.

When planning a kidney transplant for diabetes, doctors try to estimate how likely the patient is to have a cardiovascular event (heart attack or stroke) during or after the operation. To do this, the patient undergoes various examinations, including a stress ECG.

Often the results of these examinations show that the vessels supplying the heart and/or brain are too damaged by atherosclerosis. For more details, see the article “”. In this case, before kidney transplantation, it is recommended to surgically restore the patency of these vessels.

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Diabetes mellitus is a fairly common disease of the endocrine system. This disease develops with an absolute or relative deficiency of insulin, a pancreatic hormone. With such a shortage, patients experience hyperglycemia - a constant increase in the amount of glucose in the body. It is impossible to completely cope with such a disease; you can only maintain the patient’s condition in relative order. quite often leads to the development of various complications, including diabetic nephropathy, the symptoms and treatment of which we will now consider on the website, as well as the stages of the disease and, of course, the drugs used for this disease, in a little more detail.

Diabetic nephropathy is a rather serious disease, which is, in fact, a complication of diabetes mellitus on the kidneys.

Symptoms of diabetic nephropathy

The disease nephropathy can manifest itself in different ways, depending on the stage of the disease. So at the initial stage of this pathology, the patient does not experience any pronounced symptoms of the disease, however, laboratory tests show the presence of protein in the urine.

The initial changes do not provoke any disturbances in well-being, however, aggressive changes begin in the kidneys: thickening of the vascular walls occurs, a gradual expansion of the intercellular space and an increase in glomerular filtration.

At the next stage - in the pre-nephrotic state - an increase in blood pressure is observed, while laboratory tests show microalbuminuria, which can vary from thirty to three hundred milligrams per day.

At the next stage of the development of the disease - with nephrosclerosis (uremia) a persistent increase in blood pressure occurs. The patient experiences constant swelling, and sometimes blood is found in the urine. Studies show a decrease in glomerular filtration rate, an increase in urea and creatinine. Protein increases to three grams per day, but its amount in the blood decreases by an order of magnitude. Anemia occurs. At this stage, the kidneys stop excreting insulin, and there is no glucose in the urine.

It is worth noting that from the initial stage of development of the disease to the onset of a severe form of the disease, it can take from fifteen to twenty-five years. Eventually, the disease becomes chronic. In this case, the patient is worried about excessive weakness and fatigue, and his appetite decreases. Patients also experience dry mouth and lose a lot of weight.

Chronic diabetic nephropathy is also manifested by frequent headaches and unpleasant ammonia odor from the mouth. The patient's skin becomes flabby and dries out, and the activity of all internal organs is disrupted. Pathological processes lead to severe contamination of the blood, as well as the entire body, with toxic substances and decay products.

Diabetic nephropathy - stages

The Ministry of Health of the Russian Federation adopted the division of diabetic nephropathy into three stages. According to this classification, the stages of diabetic nephropathy are the stage of microalbuminuria, the stage of proteinuria with preservation of nitrogen excretory activity of the kidneys, as well as the stage of chronic renal failure.

According to another classification, the disease nephropathy is divided into 5 stages, which depend on the glomerular filtration rate. If its readings are more than ninety ml/min/1.73 m2, they speak of the first stage of kidney damage. When the glomerular filtration rate decreases to sixty to ninety, one can judge about a slight impairment of kidney function, and when it decreases to thirty to fifty-nine, one can judge about moderate kidney damage. If this indicator decreases to fifteen to twenty-nine, doctors talk about severe impairment of kidney function, and if it decreases to less than fifteen, about chronic renal failure.

Diabetic nephropathy - treatment, drugs

Disease correction

For patients with diabetic nephropathy, it is extremely important to normalize blood sugar levels to six and a half to seven percent glycated hemoglobin. Optimizing blood pressure levels also plays an important role. Doctors are taking measures to improve lipid metabolism in patients. It is extremely important for patients with diabetic nephropathy to adhere to a dietary diet, limiting the amount of protein in the diet. Of course, they need to stop consuming alcoholic beverages.

The patient’s daily diet should contain no more than one gram of protein. You also need to reduce your fat intake. The diet should be low-protein, balanced and rich in sufficient amounts of useful vitamins.

How is diabetic nephropathy treated, what medications are effective?

Patients with diabetic nephropathy are usually prescribed ACE inhibitors (or Fosinopril), which control high blood pressure and protect the kidneys and heart. The drugs of choice are often long-acting medications that need to be taken once a day. If the use of such drugs leads to the development of side effects, they are replaced with angiotensin-II receptor blockers.

Patients with diabetic nephropathy are usually prescribed medications that reduce the amount of lipids as well as cholesterol in the body. It can be either Simvastatin. They are usually used in long courses.

To effectively restore the number of red blood cells, as well as hemoglobin in the body, patients are prescribed iron supplements, represented by Ferroplex, Tardiferon and Erythropoietin.

To correct severe swelling in diabetic nephropathy, diuretics are usually used, for example, Furosemide, or.

If diabetic nephropathy leads to the development of renal failure, hemodialysis cannot be avoided.

Additional Information

Patients with diabetic nephropathy will benefit not only from medications, but also from herbal medicines. The advisability of such alternative treatment must be discussed with your doctor.

So, with such a violation, a collection made up of equal parts of yarrow grass, motherwort, oregano, horsetail and calamus rhizomes can help. Grind all the ingredients and mix them together. Brew a couple of tablespoons of the resulting mixture with three hundred milliliters of boiling water. Heat in a water bath for a quarter of an hour, then leave for two hours to cool. Take the strained medicine a third to a quarter glass three times a day, about half an hour before meals.

Celweed will help to cope with hypertension in diabetic nephropathy. Brew ten grams of dry herb with one glass of just boiled water. Leave the product to infuse for forty minutes, then strain. Take it one tablespoon immediately before meals three times a day.

Patients with diabetic nephropathy will also benefit from medicine based on. Brew a couple of tablespoons of this raw material with three hundred milliliters of boiling water. Place the product over low heat, bring it to a boil and pour into a thermos. After half an hour of infusion, strain the medicine and drink it fifty milliliters immediately before meals for two weeks.

Patients with nephropathy can also benefit from taking medicine based on strawberry leaves and berries. Combine them in equal proportions, pour a glass of boiling water and boil for ten minutes. Take the finished medicine, twenty grams three times a day.

For nephropathy, traditional medicine experts advise mixing one part of cornflower, the same amount of birch buds, two parts of bearberry and four parts of three-leaf watch. Brew a spoonful of the resulting mixture with a glass of just boiled water and simmer over low heat for ten to twelve minutes. Strain the finished broth and drink it in three doses a day.

Patients with nephropathy can use other herbal infusions. For example, they can combine thirty grams of St. John's wort with twenty-five grams of coltsfoot, the same number of yarrow flowers and twenty grams of nettle. Grind all the ingredients and mix them well together. Brew forty grams of this raw material with a glass of boiling water. Leave the product to infuse, then strain and drink in two doses. Take this medicine for twenty-five days.

Diabetic nephropathy is a rather serious complication of diabetes mellitus, which does not always make itself felt. For timely detection of such a disease, patients with diabetes need to undergo systematic tests. And treatment of diabetic nephropathy should be carried out under the supervision of a doctor.

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Diabetic angioretinopathy is a specific complication of diabetes mellitus; the pathology develops 7-10 years after the onset of problems with glycemic levels. Over time, even with compensation for the disease, the patient’s quality of vision decreases and complete blindness occurs. Since the pathological process proceeds rather slowly, it can be, if not stopped, then at least suspended. Otherwise, all changes in the organ of vision will be irreversible.

It is customary to distinguish several degrees of retinopathy: non-proliferative, pre-proliferative, proliferative, terminal. In the first case of the disease, it is possible to reverse all processes occurring in the body.

This form of the disease can last from a year to a couple of years, if hyperglycemia is compensated, blood pressure remains within normal limits, low-density cholesterol levels are minimal, and retinopathy may disappear forever.

The preproliferative form of the disease is the so-called point of no return; it is almost impossible to get rid of eye problems. However, there is a chance to slow down the progression of the disease, but only if the patient regularly undergoes tests and follows all the instructions of his doctor.

In the proliferative form, a diabetic suffers from severe complications of retinopathy, and it is extremely difficult to achieve positive dynamics of the disease. At this stage you need:

1. frequent consultations with an endocrinologist and ophthalmologist;
2. prescription of special treatment.

The patient is now experiencing partial loss of visual function.

The terminal stage is the last stage of the disease, when irreversible consequences occur. Due to blood stains, light is blocked and the vitreous body of the eye is obscured. Clots greatly weigh down the retina of the eye, causing it to peel off. These processes begin much earlier, but when the lens is unable to retain light rays on the macula as before, a person loses vision permanently.

What is proliferative retinopathy

Diabetic angioretinopathy begins with a proliferative form, when active growth of new blood vessels occurs. You might think that there is nothing bad at all in this process; the first discomfort is observed at the moment when control over the growth of blood vessels is completely lost.

As a result, small vessels appear in places where they should not be. This often occurs in the anterior chamber of the eye, where glaucoma subsequently develops.

New blood vessels are quickly damaged and are not durable, bleeding begins in the eyes, the retina and vitreous body are damaged, and blood penetrates the eyeball.

Due to frequent bruising, one of the following disorders occurs, depending on the severity of the condition:

1. partial loss of vision;
2. blindness.

Sunlight cannot pass through the thick blood that covers the retina. This is the whole reason for losing the ability to see.

In the place where excess tissue accumulates, retinal detachment also occurs. This happens as a result of the fact that the vitreous body pulls on the retina, moving it away from the attachment point, breaking the connection with the nerve endings. During detachment, the retina is deprived of its blood supply, and complete or partial tissue death is observed.

At the proliferative stage, vision loss is a matter of time; it is necessary to prepare to maintain normal well-being as much as possible. Otherwise, progressive blindness cannot be avoided.

Nonproliferative retinopathy of both eyes

Sugar level

If diabetes mellitus fails to control blood sugar levels, pathological changes gradually occur on the walls of the small blood vessels of the eyes. The vessels become heterogeneous and thinner. Microscopic aneurysms gradually appear, by which we must understand the expansion of the vascular walls.

As the microaneurysm progresses, hemorrhages appear, the greater the number of hemorrhages, the worse a person’s vision. But in this case, hemorrhages cannot yet be called characteristic symptoms. They are sometimes compared to very small dots or strokes.

Thin vascular walls cannot provide reliable protection for the eyes; they cannot act as a barrier. Thus, lipids penetrate into the retina of the eye and settle there, forming a solid exudate. When a person with diabetes still has elevated blood cholesterol levels, such exudates become more and more common.

If a diabetic monitors his health, monitors his cholesterol and keeps it within acceptable limits, such changes will disappear.

Diabetic angioretinopathy

Diabetic angioretinopathy is the most severe form of eye damage; prolonged deficiency of blood supply to the retina causes oxygen starvation. As a result, hypoxia is observed, which will cause blindness.

The pathology slowly progresses over a decade after the diagnosis of diabetes mellitus; depending on the type of hyperglycemia (type 1 or type 2 diabetes), the symptoms and nature of angioretinopathy are formed.

At the beginning of the disease, the doctor can see exudates, hemorrhages, microaneurysms. To diagnose the disease, the doctor needs to examine the condition of the visual organ. Symptoms also include microaneurysms, varicose veins, and uneven sizes of fiber vessels.

Against the background of diabetes mellitus, 2 stages of the disease are diagnosed:

• non-proliferative;
• proliferative.

In the proliferative form, visual function decays. In order to promptly determine the progression of the disease, the course of diabetes mellitus should first be monitored.

High-quality, adequate treatment of metabolic disorders helps slow the development of blindness.

Symptoms of retinopathy due to diabetes

Retinopathy occurs practically without any symptoms; the initial stage passes for a diabetic without obvious signs. It is noteworthy that the patient may not even notice how his vision is falling. But at the same time the process can be seriously neglected.

The first alarming symptom will be a veil before the eyes, it covers the eyes, vision deteriorates due to hemorrhage inside the eye. After this, dark floating circles appear in patients, after a while they may disappear on their own.

In addition to the veil and circles, problems are noted when reading small print and working with small objects at a short distance from the eyes. This feature may be individual in nature and is not observed everywhere.

Thus, there are no obvious symptoms of retinopathy in diabetes mellitus; the only thing that exists is a temporary deterioration in the quality of vision.

Over the years, due to frequent hemorrhages, the deterioration in vision will become more noticeable and distinct.

Drugs for the treatment of eye diabetes

Diabetic angioretinopathy requires treatment, which depends on the extent and progression of the original disease. Medicines are effective at one stage of the disease, but do not bring any benefit at another. For this reason, the entire therapy process must be monitored by a doctor.

Various herbal and chemical agents are prescribed. The medicine Neurovitan is produced on the basis of vitamin B, its use does not cause unwanted reactions in the body, the product is absolutely safe and harmless. An analogue will be the drug Vitrum Vision Forte.

Another remedy is Ginkgo Biloba, the medicine is produced in the form of capsules, taken like vitamin complexes - 2 pieces per day. To get real results, you will need to take the drug continuously for at least one month.

If you have eye problems with diabetes, it is good to prescribe the medication Retinalamin; it helps to achieve positive dynamics of the disease at its very beginning. Medicine:

• stimulates retinal tissue;
• reduces the inflammatory process.

A characteristic feature of the product is to inject it directly into the eyelid, after diluting it with water for injection.

Vasomag is used to improve blood circulation, tissue nutrition, and normalize metabolic processes. The drug will slow down the manifestation of pathology.

Capsules for a positive effect on the retina and capillaries are Troxevasin, Venoruton. Thanks to the use of the product, the first stage of eye disease is successfully treated.

The most effective will be Emoxipin eye drops; the liquid is contained in ampoules, from where it is taken using a syringe and dripped directly into the eyes. In many cases, the drug is administered by injection, but this is done by medical workers in a medical facility.

It is necessary to drip 4 times a day, 2 drops, the duration of treatment is 2 months.

How to treat eye diabetes with folk remedies?

In addition to traditional means of treating angioretinopathy, it is recommended to use traditional recipes. Nettle has proven itself well, namely its fresh leaves. Juice is prepared from the plant, and a glass of this drink is drunk every day.

Nettle leaves can be added to vegetable salads, soups and other first courses can be prepared from nettle. When it is not possible to use fresh nettle leaves, you can purchase dried leaves instead. But the plant should not be abused, otherwise the body may react inadequately to treatment.

It is useful to use a plant such as aloe. It is good because the plant grows on the windowsill without any problems. The main condition is that the aloe bush must be at least three years old. Take the largest sheets, cut them with a knife, wash them under running water, and then wrap them in newspaper and leave them in the refrigerator for 12 days.

After this time:

1. the sheets are crushed using a blender;
2. squeeze in gauze;
3. boil for 2 minutes in a water bath.

This product cannot be stored for a long time; each new portion is used immediately after preparation. It is enough to take a teaspoon three times a day half an hour before meals. If the doctor does not prohibit it, aloe juice is dripped into the eyes before going to bed, 2-3 drops in each eye are enough.

You can also use pollen; you buy it at the pharmacy, since you won’t be able to collect it yourself. Tinctures are prepared from the product and taken 3 times a day. One serving is a maximum of a teaspoon.

A significant limitation is if the diabetic has an allergic reaction or, in this case, pollen cannot be taken. If a patient with diabetes does not know about the allergy, you must first drink the tincture for a couple of days and monitor your well-being. If the slightest signs of allergy appear, stop taking pollen.

Treatment of eye diabetes is practiced using calendula tincture:

• 3 teaspoons of flowers are poured into 500 ml of boiling water;
• leave for 3 hours.

When ready, filter the product and take it 4 times a day. The eyes are additionally washed with the product.

Blueberry tincture helps to get rid of the inflammatory process in the eyes and complications; fresh berries should be poured with a glass of boiling water. After 1 hour, the product is taken orally; it will also help prevent retinopathy.

In the first stage of angioretinopathy, it is recommended to take lingonberry juice. The berries are crushed in a blender and poured with a small amount of water. In general, it is useful even in its raw form.

In conclusion, it is necessary to note another effective remedy against eye damage in diabetes mellitus, this is a summer collection. For treatment, you need to take burdock root, bearberry, birch leaves, willow leaves, mint, bean leaves, young knotweed grass, large walnut leaves. All ingredients are taken in equal proportions, crushed and mixed. A tablespoon of the collection is poured into two glasses of boiling water, infused, filtered and taken half a glass 30 minutes before meals. Duration of treatment is 3 months; breaks are prohibited during therapy.

Information about what complications of diabetes mellitus can develop in the visual organs is provided in the video in this article.