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Quản lý điều trị hiện tại của bệnh thận tiểu đường
Tóm tắt
Khoảng 40% bệnh nhân mắc tiểu đường phụ thuộc insulin (IDDM) phát triển bệnh thận tiểu đường với triệu chứng protein niệu, tăng huyết áp và giảm tỷ lệ lọc cầu thận trong vòng 10 đến 20 năm sau khi khởi phát bệnh, và 5 năm sau đó, hầu hết bệnh nhân đều mắc bệnh thận giai đoạn cuối. Microalbumin niệu, được định nghĩa là tỷ lệ đào thải albumin qua nước tiểu (UAER) từ 30 đến 300 mg/ngày, dự đoán mạnh mẽ sự phát triển của bệnh thận ở IDDM. Gần như tất cả bệnh nhân mắc IDDM có tỷ lệ lọc cầu thận giảm và UAER >300 mg/ngày đều có bệnh tăng huyết áp song hành, làm gia tăng chức năng thận suy giảm. Chúng tôi xem xét các kết quả của các nghiên cứu dài hạn gần đây về quản lý điều trị hiện tại ở bệnh nhân tiểu đường thông qua việc kiểm soát huyết áp tốt hơn, chế độ ăn ít protein và kiểm soát glucose máu gần như bình thường trong giai đoạn microalbumin niệu sớm cũng như trong các giai đoạn muộn của bệnh được đặc trưng bởi bệnh thận tiểu đường với UAER >300 mg/ngày. Vì phần lớn các nghiên cứu đã được thực hiện trên bệnh nhân IDDM, nên các kết luận của chúng tôi về điều trị chỉ có giá trị trong nhóm bệnh nhân tiểu đường này.
Từ khóa
#bệnh thận tiểu đường #tiểu đường phụ thuộc insulin #microalbumin niệu #tăng huyết áp #tỷ lệ lọc cầu thậnTài liệu tham khảo
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