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Causes and Diagnosis of Diabetic Kidney Disease

Causes and Diagnosis of Diabetic Kidney Disease 1

Causes of Diabetic Nephropathy

Core tip: The occurrence of diabetic nephropathy is closely related to hyperglycemia. Poor blood sugar control can accelerate the development of diabetic nephropathy, while good blood sugar control can significantly delay its development. Hyperglycemia and increased production of glycation end products cause mesangial cell proliferation, increased extracellular matrix, mesangial expansion, and glomerular basement membrane thickening.

Diabetic nephropathy is one of the common complications of diabetes and an important cause of death. However, many people do not know the cause of diabetic nephropathy due to their limited knowledge of diabetes. So what are the causes of diabetic nephropathy?

Causes and Diagnosis of Diabetic Kidney Disease

1. High blood pressure. Hypertension is not directly related to the occurrence of diabetic nephropathy, but elevated blood pressure in the original hypertension or during the course of the disease to the microalbuminuria stage can accelerate the progression of diabetic nephropathy and the deterioration of renal function, and aggravate the excretion of urinary albumin.

2. High blood sugar. The occurrence of diabetic nephropathy is closely related to hyperglycemia. Poor blood sugar control can accelerate the development of diabetic nephropathy, while good blood sugar control can significantly delay its development. Hyperglycemia and increased production of glycation end products cause mesangial cell proliferation, increased extracellular matrix, mesangial expansion, and glomerular basement membrane thickening.

3. Abnormal renal blood flow. During hyperglycemia, there is hyperperfusion and hyperfiltration in the glomerulus, and the pressure across the capillary wall increases, causing mesangial cells to expand, epithelial cell foot processes to fuse and produce dense droplets, and glomerular epithelial cells to fall off from the basement membrane. . The messenger RNA of type IV collagen in the glomerular basement membrane increases, thickening the basement membrane, and eventually forms diffuse and nodular lesions of the mesangium, leading to glomerulosclerosis. Under conditions of increased pressure, protein filtration increases and can also be deposited in the mesangial area and glomerular basement membrane, promoting matrix proliferation, forming a vicious cycle, and can cause nodular and diffuse glomerulosclerosis.

Diabetic nephropathy, how much do you know

Laboratory markers for early prediction and diagnosis of DKD

1.The significance of early prediction and diagnosis of DKD

Early diagnosis of DKD is particularly important. General studies believe that renal function damage when eGFR<30 mL·min-1·1.73 m-2 is irreversible. Starting drug intervention as early as possible can delay the onset of organic kidney disease. Timely detection of early glomerular, renal tubular and renal interstitial lesions is beneficial to the early diagnosis and treatment of DKD. A retrospective study including 121,395 patients showed that early diagnosis of DKD can reduce the risk of progression to end-stage renal disease by 80%.

Possible kidney damage in diabetic patients can be promptly assessed according to the process in Figure 2 to facilitate early detection and early intervention.

2. Biomarkers for early prediction of DKD

Urinary biomarkers in diabetic patients can indicate the location of kidney damage, potential causes, and pathophysiological processes in DKD. Table 3 summarizes the main biomarkers that may help in early prediction of DKD.

In addition to eGFR and UACR, more and more literature reports that other laboratory test indicators can be used to evaluate DKD. Table 4 lists the biological markers commonly used in laboratories to evaluate DKD and their potential clinical application value.

3. Precautions for urinary biological markers

Before analysis, attention should be paid to the sample retention time and container, storage conditions and stability, other factors that can cause changes in protein in urine (such as abdominal surgery, infection, high fever, high-protein diet, etc.), and sample processing before testing.

In order to reliably screen detection methods during analysis, it is recommended to use quantitative urine albumin concentration detection. The immunoscattering turbidimetry method has high sensitivity and specificity and a wide linear range, but requires a special protein analyzer. The immunotransmission turbidimetry method is simple to operate, but its sensitivity and specificity are not as good as the immunoscattering turbidimetry method. In addition, appropriate selection of processing methods beyond the detection range, calibration of creatinine, and routine urine examination are also required.

After analysis, since standardization of testing for urine components (especially protein) has not yet been completed, test results may vary between different testing systems, and this should be taken into account when assessing changes in patient results before and after. It is recommended to use the same detection system when testing a certain indicator in the patient’s urine.

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Monitoring of DKD

For patients with type 1 diabetes of ≥5 years duration, all patients with type 2 diabetes, and all patients with hypertension, urinary albumin, eGFR, and other biomarkers reflecting tubular and glomerular damage should be quantitatively assessed at least annually. substances (such as urinary α1-MG, urinary RBP, u-TF, urinary IgG). When the above indicators are abnormal, potential complications of CKD need to be evaluated and treated.

The treatment of DKD is an integrated process, emphasizing the treatment of the cause and comprehensive prevention and treatment. While referring to the treatment guidelines, attention should be paid to the individualization of treatment targets. Treatment strategies for DKD include improving unhealthy lifestyle, adjusting nutrition, controlling proteinuria, and intensifying blood sugar lowering. In addition, attention should also be paid to controlling blood pressure, correcting blood lipid disorders, and improving traditional cardiovascular risk factors.

Outlook

While albuminuria screening and evaluation of DKD are commonly used, attention to the detection of renal tubular injury markers can help identify earlier DKD, monitor the progression of DKD, determine the extent and prognosis of kidney damage, and determine therapeutic intervention. The effect has important clinical value.

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