Kidney crisis in diabetic patients: how to avoid the 'sweet burden'?

In modern society, the incidence of diabetes is increasing, and more and more people are troubled by this chronic disease. The harm caused by diabetes is not limited to abnormal fluctuations in blood sugar. The series of complications it causes seriously threaten the health of patients, among which kidney crisis is particularly prominent. Diabetic nephropathy, as one of the common and serious microvascular complications of diabetes, is vividly called a "sweet burden", which puts heavy pressure on the quality of life and health of patients. It is crucial for diabetic patients to understand the mechanism of diabetes-induced kidney crisis and master effective prevention measures.

How diabetes triggers a kidney crisis

1. Renal microvascular disease caused by hyperglycemia : Being in a state of hyperglycemia for a long time is like letting the microvessels of the kidneys soak in "sugar water". Hyperglycemia can damage the endothelial cells of the renal microvessels, increase the permeability of the blood vessel walls, and cause the leakage of substances such as proteins, which in turn triggers a series of pathological changes. As an important filtering unit of the kidney, the glomerulus has a rich capillary network and is most significantly affected. The glomerular basement membrane gradually thickens, and the mesangial cells proliferate, causing the filtration function of the glomerulus to gradually decline. As the disease progresses, the glomerulus will gradually harden, lose its normal filtering function, and eventually lead to renal failure.

2. Impact of metabolic disorders : There are many metabolic disorders in diabetic patients, such as abnormal lipid metabolism and oxidative stress. Abnormal lipid metabolism will lead to increased lipid content in the blood. These lipids will deposit on the walls of kidney blood vessels to form atherosclerotic plaques, further aggravating the stenosis and blockage of kidney blood vessels and affecting the blood supply to the kidneys. Oxidative stress will produce a large number of free radicals. These free radicals are highly oxidizing and will attack kidney cells, causing cell damage and apoptosis. At the same time, oxidative stress will also activate the inflammatory signaling pathways in the body, triggering an inflammatory response and further damaging kidney tissue.

3. Changes in renal hemodynamics : Hyperglycemia can stimulate the kidneys to secrete some vasoactive substances, such as activation of the renin-angiotensin-aldosterone system (RAAS). This can cause the renal arterioles to contract, especially the afferent arterioles, which increases the pressure in the glomeruli. The long-term high pressure, high perfusion, and high filtration state of the glomeruli can accelerate glomerular sclerosis and the decline of renal function.

How to avoid the "sweet burden"

1. Strictly control blood sugar : Controlling blood sugar is the key to preventing diabetic nephropathy. Patients should follow the doctor's advice and use hypoglycemic drugs, such as oral hypoglycemic drugs or insulin. At the same time, pay attention to diet control, reasonably distribute the intake of carbohydrates, proteins and fats, and avoid the intake of high-sugar, high-fat and high-salt foods. Moderate exercise can also help control blood sugar and enhance the body's sensitivity to insulin. Patients should monitor blood sugar regularly, adjust treatment plans according to blood sugar changes, and control blood sugar within the ideal range. In general, glycosylated hemoglobin (HbA1c) should be controlled below 7%. For young patients with a short course of disease and no complications, the target can be controlled below 6.5%.

2. Control blood pressure : Hypertension is an important risk factor for diabetic nephropathy. The two affect each other and form a vicious cycle. Diabetic patients should pay close attention to changes in blood pressure and control blood pressure below 130/80 mmHg. Blood pressure can be controlled through lifestyle intervention and drug therapy, such as reducing sodium intake, increasing potassium intake, exercising moderately, quitting smoking and limiting alcohol. Commonly used antihypertensive drugs include angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARB). These two types of drugs can not only effectively lower blood pressure, but also have unique kidney protection effects, which can reduce proteinuria and delay the deterioration of renal function.

3. Reasonable diet : In addition to controlling sugar intake, diabetic patients should also pay attention to protein intake. For patients with early diabetic nephropathy, protein intake can be controlled at 0.8-1.0 grams per kilogram of body weight per day; when a large amount of proteinuria or renal dysfunction occurs, protein intake should be further reduced to 0.6-0.8 grams per kilogram of body weight per day. Choose high-quality protein, such as eggs, milk, fish, lean meat, etc., and avoid eating too much plant protein. At the same time, increase the intake of dietary fiber and eat more vegetables, fruits, whole grains and other foods, which will help control blood sugar and blood lipids and reduce the burden on the kidneys.

4. Regular physical examinations : Regular renal function tests, urine routine tests, and urine microalbumin tests are important means of early detection of diabetic nephropathy. Generally speaking, patients with type 2 diabetes should undergo the above tests once a year after diagnosis, and patients with type 1 diabetes should undergo annual examinations 5 years after onset. Early detection and timely intervention can effectively delay the progression of diabetic nephropathy.

5. Avoid nephrotoxic drugs : When seeking medical treatment, diabetic patients should inform their doctors of their history of diabetes and avoid using drugs that are harmful to the kidneys, such as certain antibiotics, non-steroidal anti-inflammatory drugs, etc. If these drugs must be used, they should be used under the guidance of a doctor, with strict control of dosage and duration of use, and close monitoring of renal function.

Diabetic patients face a severe kidney crisis, but by strictly controlling blood sugar and blood pressure, eating a proper diet, having regular physical examinations, and avoiding the use of nephrotoxic drugs, we can effectively avoid this "sweet burden", protect kidney health, and improve the quality of life. Diabetic patients should actively fight the disease, build confidence, and manage the disease scientifically under the guidance of doctors, so that their lives are not disturbed too much by the disease as much as possible.