2014年5月7日星期三
Hypertension, Diabetes and Renal Failure
With the development of our life.Hypertension,Diabetes has become one of frequently-occurring disease.If one person suffering from this disease for some years.This person's kidney may be damaged.If this person can't get the right treatment may lead to kidney failure.
Hypertension and diabetes have reached epidemic proportions in the United States. Most of the burden of caring for affected patients falls squarely on the shoulders of primary care physicians. Since patients with these conditions are at high risk for cardiovascular and renal disease, the question is whether there is a quick, inexpensive, and reliable test to screen patients who have hypertension (with or without diabetes) and those who have cardiovascular diseases who are at increased risk for renal deterioration? Urine tests, for instance, are a quick, inexpensive, and reliable way to identify microalbuminuria, albuminuria, and proteinuria.
What works optimally and efficiently in the primary care setting?
To find out, Clark and colleagues1 followed 2574 persons for 7 years, assessing proteinuria (not albuminuria) by simple urine dipstick as well as spot urine albumin-creatinine ratio (ACR). The team also measured glomerular filtration rate (GFR) (7 readings during the study) and estimated the rate of kidney function deterioration in an effort to predict rapid kidney function decline (RKFD—defined as >5% decline/year).
Not surprisingly, people with RKFD were older and had a higher incidence of elevated blood pressure, diabetes (family and personal occurrence), and cardiovascular disease. Dipstick proteinuria (estimate >1 gm/L) was a stronger predictor of RKFD than the spot urine albumin/creatinine ratio. Although simple, inexpensive, and quick, the screening strategy correctly identified a progressive kidney problem in 90.8% of patients. The incidences of incorrect and missed diagnosis of RKFD were 1.5% and 7.7%, respectively.
Applying these results to clinical practice, here is the take-home message: if your population includes patients older than 60 years who have hypertension, diabetes, or cardiovascular disease, adding dipstick urine protein positivity to your screening increases the probability of discovering RKFD from|13% to 44%. This is based on a sample estimating smaller (>1 g /L) protein excretions. If the dipstick is positive for a greater (>3 g/L) amount of protein, the likelihood of RKFD increases by 7.8 times. Of course, we should not overlook albuminuria either. Although not quite as simple or quick to measure as an office dipstick test, this study found that a high albumin values conferred a 53% greater risk for RKFD.
The findings of this study were so straightforward that it boggles the mind. In an era of expensive, invasive testing, just “dipsticking” a urine sample in an ambulatory setting in a high-risk population gives primary care physicians important information about their renal prognosis.
In this study, 90% of the participants were white. Hopefully, further study will corroborate these findings in ethnically dissimilar populations as well.
Treatments of Renal Failure
To control diabetic, you can try some anti-hyperglycemic agents, either oral or injected, with doctors’ guidance.
To treatment diabetic nephropathy you can try Traditional Chinese Medicine.In one hand it can regulate blood sugar level naturally.In other hand it can restore kidney damage gradually.
Micro-Chinese Medicine Osmotherapy include the advantage of Traditional Chinese Medicine and in other hand it in virtue of the western machine.So this therapy Can let the Chinese herb enter your kidneys directly.
if you have any questions about your kidney disease,or if you have interested in this therapy.Contact me through kidney-treatment@hotmail.com .
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