Protein in urine diabetes: causes of and treatments

This pathology is seen in 32% of patients with CRF (chronic renal failure), who are on renal replacement therapy.

Kidney damage in patients with diabetes mellitus (DM), considered a manifestation of nephroangiosclerosis, diabetic nephropathy and the concomitant complication of pyelonephritis.

In prognostic terms, the most adverse consequences is diabetic nephropathy, which develops in 45% of patients with diabetes mellitus 1 and 2 type. One of the leading laboratory signs of this disease is the appearance of protein in the urine in diabetes.

In patients with type 1 diabetes symptoms of nephropathy is diagnosed, on average, after 7 years since the onset of the disease. Diabetic nephropathy in type 2 diabetes is often detected at the same time.

Causes of protein in urine in diabetes

The mechanisms that lead to the development of nephropathy and the emergence of protein in urine in diabetes, as follows:

• the increase in the level of glucose in the cell with a metabolic disorder and failure of all cellular functions;
• the increased synthesis of cytokines;
• glikozilirovanie circulating and structural proteins of the body, which again leads to increased formation of cytokines, factors for membrane permeability, increase in extracellular matrix, etc.;
• the increase in glomerular perfusion and filtration through activation of glucagon, prostaglandins, sorbitol;
• the failure kanalzeva – glomerular feedback;
• stimulation of the renal renin-angiotensin system;
• genetic factors, etc.

The renal structures are changing: thickened basement membrane, increased mesangial matrix, start the process of glomerulosclerosis, it is often nodular (knobby) shape.

Lab reflection of these processes is the appearance of microalbuminuria, which corresponds to stage 1 (initial), diabetic nephropathy, proteinuria with nephrotic syndrome (stage 2) and renal failure (end-stage diabetic nephropathy).

According to the results of clinical trials, treatment should start at the stage of microalbuminuria, this will help to prevent further progression of nephropathy.

In order to make this possible, it is recommended to examine the urine for microalbuminuria in patients with diabetes type 1 diabetes 1 year after 5 years from start of diagnosis, and in type 2 diabetes 1 per year immediately after confirmation of the pathology.

For greater accuracy, observe a number of rules:

• the analysis is performed three times a week;
• SD should be in the stage of compensation of metabolic processes;
• the patient is given recommendations on limiting the consumption of large quantities of protein foods (meat, milk, fish, eggs, poultry, soy);
• before the tests excluded increased exercise;
• cancellation of diuretics on the day of collection of urine;
• explores the overall clinical analysis of urine on the subject of infectious processes in organs of the urogenital tract.

Heart failure decompensation and infectious diseases with the increase in temperature also affect the reliability of the analysis of microalbuminuria.

With progression of nephropathy in diabetes mellitus, urine protein (proteinuria) and, later, developed nephrotic syndrome.

The functional ability of the kidneys is lost gradually, irreversible changes associated with end-stage renal disease are recorded in 15 – 20 years from the onset of diabetes.

Clinical manifestations

Symptoms and signs of diabetic nephropathy in the stage of uremia are diverse, and affect the work of all organs and systems. As a rule, accompanies the pathological process is as follows:

How to prevent kidney failure?

The progression of nephrosclerosis contribute to the following key factors:

• elevated levels of glucose in the blood;
• hypertension (as a consequence, vnutrikletochnogo boost pressure and hyperfiltration in surviving nephrons;
• persistent increase in systemic arterial pressure;
• protein in the urine;
• violation of metabolic processes;
• factors that aggravate the course of underlying disease.

So justified will monitor the level of blood glucose from the diagnosis of diabetes.

Of great importance are the ACE inhibitors and receptor blockers to angiotensin – 2, which have renal protection effect.

Positive action of preparations from these groups:

• the decrease in the level vnutrikletochnogo hypertension and excessive filtering;
• a decrease in the allocation of protein in the urine in complicated diabetes;
• increase excretion of sodium in the urine and the conservation of potassium;
• the increase in decay of LDL (low density lipoprotein) and increased synthesis of HDL (high density lipoproteins);
• the reduction product of triglycerides;
• stimulation of the sensitivity of the receptors to insulin;
• protective action in relation to the endothelium.

Whatever drugs are not used (in the pharmaceutical market they are more than enough), you need to strive to achieve target blood pressure levels: 130/85 mm. Hg.St. (proteinuria less than 1G/day); 125/75 mm Hg.St. (proteinuria greater than 1 g/day).

To reduce the amount of protein in the urine in diabetes mellitus due to antiproteinuric actions will help the drugs of the following groups:

• ACE inhibitors and receptor blockers to angiotensin – 2;
• glycosaminoglycan (sulodexide);
• blockers endopeptidazy and so on.

In the treatment regimen include drugs that have hypolipidemic effect that slows the progression of atherosclerotic processes in patients with diabetes.

Present to your attention the list of effective lipid-lowering drugs:

• Atorvastatin;
• Cerivastatin;
• Simvastatin;
• Lovastin;
• Fluvastatin;
• Pravastin.

All these drugs have different dosage options that is useful for the selection of individual regimens.

The optimal level of blood cholesterol in the treatment of lipid-lowering drugs, should not exceed 5 mmol/l; LDL – 3 mmol/L.

Renal replacement therapy when complications of diabetic nephropathy

When the glomerular filtration rate 15 to 20 ml/min and absence of the phenomena of dyspepsia resort to renal replacement therapy.

Each method has advantages and disadvantages.

The most often used regular hemodialysis.

Of the disadvantages of the method noted more frequent episodes of hypoglycemia, lower blood pressure after a session of cleaning the blood, arises the necessity of changing of vascular access.

Patients with concomitant progressive disease of the cardiovascular system have a greater risk of an adverse outcome during hemodialysis.

The disadvantages ambulatory peritoneal blood purification include, a complication of peritonitis, the loss of protein in the dialysate.

To kidney transplantation is resorted to after an absence of effect of treatment. The operation is more promising in the prognostic plan than renal replacement therapy. In patients with the transplanted kidney in patients receiving immunosuppressive medications significantly increases the risk of complications.

Regarding the duration of life in hemodialysis and peritoneal, it is comparable and is a two-year – 60%, four – 20%.

Analyze the tactics of management of patients with proteinuria on the background of diabetes by stages of diabetic nephropathy.

Microalbuminuria

• normalization of blood glucose;
• ACE inhibitors or receptor blockers to angiotensin – 2;
• continuous monitoring of arterial pressure.

Stage of proteinuria

• normalization of blood glucose;
• ACE inhibitors or receptor blockers to angiotensin – 2;
• to control blood pressure;
• correction of cholesterol metabolism;
• symptomatic treatment of nephrotic syndrome;
• prevention of complications;
• the restriction of protein in the diet.

Stage chronic renal failure

Conservative treatment:

• normalization of glucose in the blood;
• constant dynamic tonometry;
• control of cholesterol and lipids;
• correction of electrolyte abnormalities;
• a low-protein diet;
• Antianemic therapy: iron+erythropoietin;
• ACE inhibitors and/or blockers of receptors for angiotensin 2 in small doses.

In the terminal stage of the software hemodialysis, peritoneal dialysis and kidney transplantation.