Diabetic Nephropathy and Management

Chronic kidney disease affects people worldwide. Approximately 1 out of 3 adults with diabetes have kidney disease. Among several etiological factors for CKD, diabetes mellitus (DM) and hypertension are the main factors. These factors not only cause CKD but are also responsible for several complications related to CKD. In this article, we have reviewed Diabetic Nephropathy (DN) in terms of etiology, pathophysiology, diagnosis, management, current guidelines for diabetic nephropathy management, and some of the research study findings. Diabetic nephropathy (DN) is the chief factor for end-stage renal disease (ESRD) development across the globe. The primary cause of DN is Diabetes Mellitus, which is an autoimmune lifestyle disorder having several etiological factors. Checking for urine albuminuria, estimated GFR (eGFR), and blood glucose are unswerving tests for DN diagnosis and subsequent monitoring. Controlling hyperglycemia, blood pressure, and proteinuria are critical in stopping the progression of DKD. Clinical practice and evidence-based medicine demonstrated that early diagnosis followed by treatment can prevent or halt DKD progression.

One Case of Diabetes Nephropathy Stage V, Combined Valvular Disease, Total Heart Failure with Diabetes Foot Gangrene

The patient was found to have 4+urine sugar by physical examination 14 years ago and was treated with oral hypoglycemic drugs. Insulin was injected intramuscularly nine years ago. Two and a half years ago, it was found that the color of the thumb, index and middle toe of the left foot became black. He went to a third-class hospital in Beijing and was diagnosed as “diabetes foot”. He was treated with “balloon dilation of lower limb blood vessels of diabetes foot”. Half a year ago, the third toe on the right side was broken and treated in the hospital again. “Popliteal artery stent implantation” was given for the diagnosis of “double kidney insufficiency, diabetes foot, left heart failure, combined heart valve disease”, “Hemofiltration therapy” and anti-inflammatory, amino acid supplementation, kidney function protection, anticoagulation, anemia correction and other treatments. Later, he went to our hospital and was diagnosed by the TCM diagnosis: category of consumptive disease, toe or finger gangrene (syndrome/pattern of qi and yin deficiency). Western medicine diagnosed: stage V of diabetes nephropathy, type II diabetes foot gangrene, combined with heart valve disease, hypoalbuminemia, double kidney cyst, moderate anemia, pleural effusion, hyperkalemia, pulmonary infection, and total heart failure. The patient was treated by the Qi-acupuncture therapy of TCM in combination with Chinese and Western medicine Medical treatment made the patient significantly better and discharged.

Role of angiotensin converting enzyme and angiotensinogen gene polymorphisms in angiotensin converting enzyme inhibitor-mediated antiproteinuric action in type 2 diabetic nephropathy patients

AIM To investigate the role of genetic variants of angiotensin converting enzyme(ACE) and angiotensinogen(AGT) genes in the antiproteinuric efficacy of ACE inhibitor therapy in diabetic nephropathy(DN) patients.METHODS In the present study, 270 type 2 diabetes mellitus patients with nephropathy were enrolled and treated with ACE inhibitor(ramipril) and followed at 6 mo for renal function and albumin excretion by estimating serum creatinine, end stage renal disease, and albumin/creatinine ratio(ACR) in urine. Genotyping of ACE I/D and AGT M235 T polymorphisms were performed by using primer specific polymerase chain reaction(PCR) and PCR-RFLP techniques, respectively. RESULTS Forty-eight percent of DN patients(responders) benefited with respect to proteinuria from ACE inhibitor therapy at 6 mo follow-up. A significant reduction in ACR was observed after 6 mo treatment with ACE inhibitor irrespective of whether DN patients were micro-albuminuric(≥ 30 and < 300 mg/g creatinine) or macro-albuminuric(≥ 300 mg/g creatinine) at the time of enrollment. However, macro-albuminuric patients(55%) showed better response to therapy. A reduction in urinary ACR was found independent of genotypes of ACE I/D and AGT M235 T polymorphisms although macro-albuminuric patients having TT genotype showed statistically insignificant increased response(72%). CONCLUSION ACE inhibitor therapy reduced urinary ACR by ≥ 30% in 50% of DN patients and the response is independent of ACE I/D and AGT M235 T polymorphisms.

Mechanism analysis of Traditional Chinese Medicine in treatment of Diabetic Nephropathy based on network pharmacology and Traditional Chinese Medicine inheritance support system

糖尿病肾病为糖尿病最为严重的并发症之一,早期以水肿、蛋白尿为主要临床表现,后期随着病情发展严重者则会出现肾小球硬化及肾间质纤维化,预后差,目前中医药在治疗糖尿病肾病方面有一定的优势。目前关于中医药治疗糖尿病肾病的研究越来越多,但大多集中于研究糖尿病肾病的中医分型及病因病机的总结,缺少针对中药处方作用机制的深入研究与归纳整理。本文采用中医传承系统及网络药理学BATMAN-TCM软件,搜集整理相关文献,对近十年来经临床实践及动物实验验证对治疗糖尿病肾病的确有显著疗效的中医药处方进行分析,研究其核心用药配伍规律及治疗糖尿病肾病的潜在作用信号通路和靶点。研究发现,中医药治疗糖尿病肾病的核心中药配伍味山茱萸、茯苓、山药三味中药,此配伍富集与糖尿病肾病的信号传导通路及靶点有密切的联系,并且对蛋白尿、糖代谢紊乱、水肿等临床症状的改善有积极作用,深入探讨核心配伍山茱萸、茯苓、山药三味中药对糖尿病肾病的治疗效果,以期为中医药治疗糖尿病肾病的研究及临床治疗提供参考。

Research Progress of Treating Diabetic Nephropathy with Traditional Chinese Medicine

By collecting and sorting out the literature and journals on the clinical use of Chinese medicine in the treatment of diabetic nephropathy in recent years,it is concluded that Chinese medicine is effective in the treatment of DKD.Chinese medicine therapy has a unique role in the treatment of diabetic nephropathy.How to correct syndrome differentiation and treatment?Improving clinical effects is the research direction that all medical staff will work together in the future.

The Present Situation of TCM Treatment for Diabetes and its Researches

Diabetes is a frequently encountered disease. There are now approximately 40 million diabetes patients in China1, most of them with diabetes II.

Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Study of 82 Patients and Review of the Literatures

Background: Worldwide, diabetic nephropathy-DN is the leading cause of end-stage kidney disease-ESKD, DN is a common cause of renal failure with a reported frequency of 10% - 15% in type-2-diabetes-mellitus-T2DM patients, however there is a great discrepancy between countries. The aim of the pre-sent study is to evaluate the findings of kidney biopsies performed on diabetic patients. Materials and Methods: We studied native kidney histopathological findings in the period from January 2016 till end of December 2018 done for patients with T2DM with chronic kidney diseases-CKD. Results: A total of 82 DM-patients, 50 males (61%) and 32 females (39%) with age mean (95% CI) of 50.8 (47.1 - 55.2) years for all patients, ranged between 15 to 65 years. Histological findings showed that 57.3% of patients had DN. While focal-segmental-glomerulosclerosis-FSGS was present in 20.7%—primary in 8.6% and secondary in 12.1%. IgA represented 4.9%, while Lupus nephritis, Membranous and drug induced interstitial nephritis were each present in 3.7%. MCD was present in 2.4%. Lastly diffuse proliferative GN, ANCA associated glomerulonephritis, and hypertensive nephrosclerosis accounted for 1.2%. Conclusion: The prevalence of NDKD is remarkably frequent in DM patients who underwent kidney biopsy and FSGS was the most frequent diagnosis. To get a proper histopathological diagnosis, an adequate tissue biopsy is needed with an adequate number of glomeruli. There is a great need for more consideration to biopsy diabetic patients, as the finding of NDKD requires a different therapeutic approach. This, hopefully, will help to manage these patients better and therefore, ameliorate the progression to ESKD over time and therefore delay the need for RRT.

Overview of effect of traditional Chinese medicine on diabetic kidney disease by regulating podocyte

Diabetic kidney disease has now become the leading cause of end-stage renal disease.Podocytes are an important filtration barrier of the glomerulus,and their damage plays an important role in the occurrence and progression of glomerular sclerosis and DKD.This article discusses the molecular mechanism of traditional Chinese medicine on the protection of podocyte damage in diabetic kidney disease from the aspects of anti-oxidative stress,activating autophagy,and regulating signal pathways,in order to further deepen the modern material basis theory of traditional Chinese medicine treatment and provide reference for the treatment of DKD.

复方丹参滴丸联合雷米普利片对糖尿病肾病患者肾功能、P选择素水平及糖脂代谢的影响

目的观察复方丹参滴丸联合雷米普利片对糖尿病肾病(DN)患者肾功能、P选择素水平及糖脂代谢的影响。方法将88例DN患者按照随机数字表法分为2组,对照组44例予雷米普利片治疗,治疗组44例在对照组治疗基础上予复方丹参滴丸治疗。2组均治疗4周。比较2组治疗前后中医证候评分、肾功能[血尿素氮(BUN)、血肌酐(SCr)及尿蛋白排泄率]、糖脂代谢[餐后2 h血糖(2 hPG)、空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TC)]、炎症因子[超敏C反应蛋白(hs-CRP)、P选择素、肿瘤坏死因子α(TNF-α)]水平及不良反应发生率。结果2组治疗后中医证候各项评分均较本组治疗前降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05)。2组治疗后BUN、SCr、尿蛋白排泄率均较本组治疗前降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05)。2组治疗后FPG、2 hPG、TG、TC水平均较本组治疗前降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05)。2组治疗后血清hs-CRP、P选择素、TNF-α水平均较本组治疗前降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05)。治疗组不良反应发生率11.36%(5/44),对照组不良反应发生率4.55%(2/44),2组比较差异无统计学意义(P>0.05)。结论复方丹参滴丸联合雷米普利片治疗DN可有效提高肾功能,改善糖脂代谢,减轻炎症反应,降低P选择素水平,安全有效。

达格列净对老年2型糖尿病肾病合并高血压患者同型半胱氨酸的影响及疗效分析

目的探究达格列净对老年2型糖尿病(type 2diabetes mellitus,T2DM)肾病合并高血压患者同型半胱氨酸(Hcy)、尿酸、胱抑素C的影响及临床疗效。方法回顾性选取2022年12月至2023年6月青岛大学附属医院收治的T2DM肾病合并高血压患者292例,根据用药情况分为达格列净组147例和对照组145例。随访3个月,记录并比较2组治疗前后Hcy、尿酸、胱抑素C、尿微量白蛋白/尿肌酐比值(UACR)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)及其他代谢相关指标。用Pearson相关性分析Hcy与尿酸的相关性,logistic回归分析T2DM肾病合并高血压患者发生蛋白尿的危险因素。结果与治疗前比较,2组治疗后体质量指数(body mass index,BMI)、收缩压、舒张压、空腹血糖、糖化血红蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、尿酸、胱抑素C、Hcy、胰岛素抵抗指数(HOMA-IR)、UACR显著降低(P<0.05);达格列净组治疗后BMI、空腹血糖、LDL-C、尿酸、胱抑素C、Hcy、HOMA-IR、UACR显著低于对照组(P<0.05,P<0.01)。Pearson相关性分析显示,Hcy与尿酸在整个人群中(r=0.560,P<0.01)、在男性中(r=0.510,P<0.01)、在女性中(r=0.640,P<0.01)均呈正相关。多因素logistic回归分析显示,总胆固醇、eGFR、男性、糖尿病周围神经病变、Hcy≥15μmol/L为老年T2DM肾病合并高血压患者发生蛋白尿的独立危险因素(P<0.05,P<0.01)。结论达格列净作为一种新型降糖药物或许可通过降低T2DM肾病合并高血压患者Hcy和尿酸水平,发挥额外的肾脏保护作用,从而减缓患者的尿蛋白并改善结局。

基于“窍”理论探讨糖尿病肾病的病机及治疗

糖尿病肾病属于中医“消渴”范畴,是糖尿病最主要且危害严重的微血管并发症之一,以微血管损伤为基本特征,病变可累及全肾,是终末期肾脏病的主要原因,严重影响糖尿病患者的生活质量以及寿命。目前,现代医学对于糖尿病肾病以生活管理、控制血糖及对症治疗为主,这些治疗通常有费用昂贵、效果不理想或者不方便等一系列问题,会给患者以及家属带来极大负担,因此急需寻求更加安全、便捷、有效的治疗手段。文章从中医“窍”理论认识糖尿病肾病,结合中医“窍”理论的来源、内涵,认为“窍”以通则和,并以中医“窍”理论解释糖尿病肾病发生发展,提出糖尿病肾病以血窍开阖失常为基本病机,引发水、糟粕窍道的运转、排泄失常。血窍不通,血液营养不足,肾脏组织功能低下,继而引发机体水液输布、代谢障碍,引起机体代谢废物排泄障碍,临床表现可见贫血、水肿、呕吐、眩晕、大便异常,辅助检查常可见蛋白尿、血脂、血尿酸、血肌酐、尿素氮升高以及肾小球滤过率进行性下降,随着病程进展,最终可导致慢性肾衰竭,提出糖尿病肾病中医治法当以活血通窍、利水逐饮、通便祛浊为基本治则,以期为临床治疗糖尿病肾病提供新的思路与方法。

中药治疗糖尿病肾病的研究进展

糖尿病肾病是指由于长期患有糖尿病而导致的肾脏损害。患者的血糖水平持续增高,且长期高血糖对肾脏造成损害,出现以蛋白尿为主的临床症状。西药仍缺乏特效药物,常规治疗是控制血糖及血压,使用血管紧张素转换酶抑制剂等药物减少蛋白尿和延缓糖尿病肾病的进展,作用靶点单一,药物不良反应较多。病情进展至终末期肾病,采用替代疗法,如透析和肾脏移植,给患者带来巨大的经济压力,同时陷入治疗困境。相比之下,中药在糖尿病肾病治疗方面拥有悠久的历史,中药具有多靶点、多成分、多角度的特点,展现出独特的优势。中医根据症状将糖尿病肾病归属于“肾消”“水肿”等范畴。文章从中医角度出发,探讨糖尿病肾病的中医病因病机,搜集了中药复方、单味中药和中药单体治疗糖尿病肾病的临床及相关机制研究类文章,以中药复方、单味中药、中药单体为框架展开综述。具体从活血化瘀法、化气行水法、清热利湿法以及其他治法探析中药复方治疗糖尿病肾病的相关文献,从单味中药治疗糖尿病肾病采用补益类、清热类、活血化瘀类中药的角度展开论述,中药单体治疗糖尿病肾病以中药单体的药物结构为划分依据,论述三者治疗糖尿病肾病的临床疗效、相关药理及机制研究,总结了现阶段中药治疗糖尿病肾病的理论证据、优势以及不足,以期为糖尿病肾病开发预防性和治疗性药物提供新思路。

五苓散治疗2型糖尿病合并代谢相关脂肪性肝病疗效观察

目的:观察五苓散治疗2型糖尿病合并代谢相关脂肪性肝病的临床疗效。方法:选取2型糖尿病合并代谢相关脂肪性肝病湿浊内停证患者60例,在生活方式干预基础上随机分为两组各30例,治疗组予五苓散口服,对照组予二甲双胍片口服,治疗12周。结果:治疗组总有效率为90.00%,对照组总有效率为70.33%,两组比较有统计学差异(P<0.05)。治疗前后两组体质指数、肝酶、稳态模型胰岛素抵抗指数、血糖、血脂及肝脏瞬时弹性成像可控衰减参数水平组内比较有统计学差异(P<0.01)。治疗后两组中医证候积分、体质指数、腰围、肝酶、稳态模型胰岛素抵抗指数、血脂及肝脏瞬时弹性成像可控衰减参数水平组间比较,治疗组优于对照组(P<0.05)。结论:五苓散治疗2型糖尿病合并代谢相关脂肪性肝病湿浊内停证患者,可明显改善患者临床症状,减轻体重,改善肝酶、血脂等生化指标水平,同时能减少肝脏脂肪含量,提高临床疗效。

五苓散化裁治疗脾虚湿盛型2型糖尿病合并肥胖疗效观察

目的:观察五苓散化裁治疗脾虚湿盛型2型糖尿病合并肥胖的临床疗效。方法:将脾虚湿盛型2型糖尿病伴肥胖的60例患者随机分为两组各30例。对照组予盐酸二甲双胍缓释片治疗,治疗组在对照组基础上予五苓散化裁治疗。12周后比较两组的临床疗效、体重指数(BMI)、腰围、空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)水平及不良反应。结果:治疗组总有效率93.33%,对照组总有效率63.33%,两组比较差异具有统计学意义(P﹤0.05);两组BMI、腰围、FPG、2hPG、HbA1c水平均较治疗前降低,差异具有统计学意义(P﹤0.05),且治疗组降低水平均优于对照组(P﹤0.05)。结论:五苓散化裁治疗脾虚湿盛型2型糖尿病合并肥胖疗效显著,能够有效改善患者临床症状,降低肥胖程度,控制血糖水平。

祛浊清源汤治疗糖尿病肾病患者的临床疗效及对其肾功能指标的影响

目的 观察祛浊清源汤治疗糖尿病肾病患者的临床疗效及对其肾功能指标的影响。方法 选取2019年9月—2021年3月期间衡水市中医医院收治的120例糖尿病肾病患者作为研究对象,按照随机数字表法分为对照组和观察组,每组各60例。两组患者均给予优质蛋白、降糖、利尿消肿等基础治疗。对照组给予依那普利治疗,观察组在对照组基础上给予祛浊清源汤口服。连续治疗16周后,观察比较两组患者临床疗效,治疗前及治疗16周后中医证候积分,肾功能指标[血清肌酐(Serum creatinine, Scr)、尿素氮(Blood urea nitrogen, BUN)、24 h尿蛋白定量(24 h urine protein quantification, 24 h UPQ)、24 h尿微量白蛋白排泄率(24 h urine microalbumin excretion rate, 24 h UAER)]水平及不良反应发生情况。结果 治疗后观察组临床总有效率93.33%(56/60)明显高于对照组78.33%(47/60),差异有统计学意义(P<0.05)。治疗后两组患者神疲乏力、少气懒言、腰膝酸软、口干咽燥、潮热盗汗、夜尿频多积分均较治疗前降低,差异有统计学意义(P<0.05);且观察组神疲乏力、少气懒言、腰膝酸软、口干咽燥、潮热盗汗、夜尿频多积分均较对照组明显降低,差异有统计学意义(P<0.05)。治疗后两组患者肾功能24 h UAER、24 h UPQ、BUN、Scr水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组肾功能24 h UAER、24 h UPQ、BUN、Scr水平均较对照组明显降低,差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 祛浊清源汤治疗糖尿病肾病疗效较好,能够明显改善中医症状,同时可以改善肾功能,具有较高安全性,具有临床推广意义。

补肾泄浊方联合常规疗法治疗糖尿病肾病的临床研究

目的探究补肾泄浊方联合常规疗法治疗糖尿病肾病的临床效果。方法选取2022年1月—2023年1月常熟市中医院接诊的60例糖尿病肾病患者为研究对象,按照随机数表法分为对照组和观察组,各30例。对照组采用厄贝沙坦+达格列净治疗,观察组应用厄贝沙坦+达格列净+补肾泄浊方治疗。对比两组患者治疗有效率、治疗前后血糖及肾功能指标变化。结果观察组治疗总有效率为96.67%,显著高于对照组,差异有统计学意义(χ^(2)=4.043,P<0.05)。治疗后,观察组血糖相关指标低于对照组,肾功能指标优于对照组,差异有统计学意义(P均<0.05)。结论针对糖尿病肾病患者采取厄贝沙坦+达格列净+补肾泄浊方治疗,可改善患者的各项指标,利于快速预后。

正清风痛宁缓释片治疗30例糖尿病肾病临床观察

目的 应用正清风痛宁缓释片医治糖尿病肾病患者,探究其临床疗效。方法 选择临床诊断为糖尿病肾病的患者60例,随机分成2组,即对照组、治疗组。对照组使用百令胶囊以及盐酸贝那普利片,治疗组在对照组基础上加用正清风痛宁缓释片。观察2组治疗前后24 h尿蛋白、血清白蛋白及疗效。结果 治疗组的治疗总有效率为83.33%(25/30),优于对照组的60.00%(18/30)(P<0.05)。对照组的24 h尿蛋白从治疗前的(1.98±0.53)g/d,降低到治疗后的(1.56±0.35)g/d;治疗组的24 h尿蛋白从治疗前的(2.15±0.42)g/d,减少至治疗后的(1.05±0.32)g/d,2组差异有统计学意义(P<0.05)。结论 正清风痛宁缓释片能明显降低糖尿病肾病患者尿蛋白水平,有效缓解糖尿病肾病的发生发展,并延缓其进展为终末期肾脏病。

疏风活血法治疗糖尿病肾病Ⅲ期临床观察

目的观察疏风活血法治疗糖尿病肾病(DN)Ⅲ期的临床效果。方法筛选60例DN患者随机分为对照组及治疗组,各30例。两组患者均给予基础的西医方式治疗,对照组加用缬沙坦胶囊口服,治疗组给予缬沙坦胶囊+疏风活肾方颗粒剂口服,治疗6个月;观察两组患者临床疗效以及治疗前后中医证候积分、中性粒细胞与淋巴细胞比值(NLR)、肾小球滤过率(eGFR)、尿β_(2)-微球蛋白(β_(2)-MG)、尿微量白蛋白(m-ALB)的变化,及NLR与尿m-ALB、尿β_(2)-MG的相关性。结果治疗后,治疗组患者中医证候总积分优于对照组(P<0.05)。治疗后,两组患者NLR、β_(2)-MG、m-ALB水平较治疗前均降低,且治疗组低于对照组;eGFR水平较治疗前均提高,且治疗组高于对照组(P<0.05);治疗前后两组NLR与尿β_(2)-MG、尿m-ALB水平均呈正相关。结论疏风活血中药可改善DNⅢ期的临床疗效,NLR与糖尿病患者肾功能水平具有相关性,可作为评估DN患者肾功能状态及DN早期诊断的指标之一。

自拟建中补肾消癥汤联合达格列净治疗糖尿病肾病临床观察

目的 分析自拟建中补肾消癥汤联合达格列净对糖尿病肾病患者的影响。方法 吉安市万安县中医院共计收治98例糖尿病肾病患者,时间为2020年1月—2022年1月,周期为2年。将98例患者随机等分为对照组与研究组,各49例。对照组采用达格列净治疗,研究组在对照组的基础上采取自拟建中补肾消癥汤治疗,对比2组患者临床疗效,治疗前后中医证候评分及血糖、肾功能指标水平。结果 研究组总有效率98.0%(48/49)高于对照组的81.6%(40/49)(P<0.05)。研究组中医证候评分显著低于对照组(P<0.05)。治疗后,研究组空腹血糖、餐后2 h血糖、糖化血红蛋白水平均低于对照组(P<0.05)。肾功能指标方面,治疗后,研究组血肌酐、尿蛋白排泄率、24 h尿蛋白定量均低于对照组(P<0.05)。结论 自拟建中补肾消癥汤联合达格列净治疗糖尿病肾病患者,与西医治疗相比效果更具有独特性,值得应用。

糖尿病肾病的中医临床研究进展

本文通过查找中医药治疗糖尿病肾病的文献并进行归纳、总结、分析,以期为该病治疗提供新的思路。