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腎臟保健

1.   認識糖尿病腎病變/Understanding Diabetic Nephropathy  2018.07.31

一、什麼是糖尿病腎病變
糖尿病腎病變是糖尿病常見的併發症之一,早期以出現微量白蛋白尿為表徵,由於病人血糖未控制好,全身大、小血管產生病變,腎臟細小血管也受到傷害,進而影響腎臟功能,據統計洗腎病人中約45%因為糖尿病引起的腎病變。


二、檢測糖尿病腎病變
1.單次驗尿出現微白蛋白尿:最為快速方便,六個月內複檢兩次的確認。



2.抽血檢驗肌酸酐指數評估腎臟功能
(腎絲球過濾率)。



3.腎臟超音波檢查腎臟是否過大或萎縮。【檢查方式由醫師依情況決定】


三、糖尿病腎病變的照護
當出現白蛋白尿要積極接受治療與照護,一旦腎臟受損傷,其功能常常是無法回復,做好日常的健康管理,是預防及延緩腎功能衰退的最好方法。
1.良好血糖控制:
血糖過高會導致微血管及大血管病變,影響腎臟血流量,造成腎功能下降。建議飯前血糖80-130mg/dl,飯後血糖小於160mg/dl,糖化血色素低於7.0%。
2.嚴格控制血壓:
高低起伏的血壓會加速腎臟的血管破壞,導致腎臟功能惡化。理想血壓應控制收縮壓140mmHg以下,舒張壓90mmHg以下;有蛋白尿患者血壓應控制收縮壓130mmHg以下,舒張壓80mmHg以下。
3.控制血脂肪:
血脂肪濃度異常也是腎功能衰退原因之一。建議低密度膽固醇(LDL)小於100mg/dl,三酸甘油脂(TG)低於150mg/dl。
4.飲食調整:
(1) 調整蛋白質食物攝取,如魚、肉、雞、鴨、蛋、奶、黃豆製品,可以減少白蛋白尿並減緩腎臟功能惡化。【建議諮詢營養師設計飲食調整計畫】
(2)避免油炸食物及高油脂食物如:
肥肉、肉皮、內臟、甜點、糕餅。有益於維持血脂肪正常濃度。
(3)清淡飲食,不食用鹽分過高的食物,如:醃漬製品、罐頭類或加工食品,有助於血壓的控制。
5.健康的生活習慣:
(1)規律運動,有助於血壓、血糖及血脂肪的控制。
(2)戒菸,有益於高血壓及蛋白尿的控制。
(3)維持理想體重避免過度肥胖,身體質量指數(BMI)18.5-24。
(4)不熬夜、不酗酒。
6.預防感染:
常見的泌尿道及呼吸道感染會影響腎臟功能。
(1)泌尿道感染的預防:如廁時,做好個人衛生習慣、勿憋尿、洗澡採淋浴方式。
(2)預防呼吸道的感染:注意氣候變化必要時多添加衣服,流行性感冒季節盡量不出入公共場所,每年10-11月接種流感疫苗以減少得到嚴重流感機會。
7.持續門診治療與追蹤
(1)遵守醫囑服藥,不可任意自行調藥或服用成分不明的偏方、草藥。
(2)定期回診配合醫護人員及營養師給予的建議與指導。
(3)糖尿病患者應該配合每年一次微量白蛋白尿測試及血液肌酸酐測定,以監測腎臟功能。



自我評量(是非題)
( )1.糖尿病腎病變,早期特徵是出現微量白蛋白尿。
( )2.血糖過高會導致小血管病變,造成腎功能下降。
( )3.糖尿病腎病變病人飲食只要控制含糖較高的食物就可以了。


參考資料:
衛生福利部國民健康署(2015).糖尿病與我,40-44。財團法人國家衛生研究院(2015).台灣慢性腎臟病臨床診療指引,226-251。
制訂日期:2007年5月
修訂日期:2017年3月(第三版)
編碼:5736-單張-中文-306-03

 

題號 1 2 3
解答 O O X

Understanding Diabetic Nephropathy
認識糖尿病腎病變

一、What is Diabetic Nephropathy?
Diabetic nephropathy is one of the common complications of diabetes. Early symptoms are the occurrence of microalbuminuria because the patient does not have good control over blood sugar, so the blood veins in the entire body will have small lesions, thereby affecting kidney function. According to statistics, about 45% of patients have renal dialysis due to diabetic nephropathy.
二、Testing for Diabetic Nephropathy
        (1). One time urine test for microalbuminuria: fastest and most convenient confirmed two times within 6 months.

Classification Urinary Albumin/Creatinine Ratio (mg/g)
¨ Normal or Mild Albuminuria   <30  
¨ Moderate albuminuria   30-300    
¨ Severe albuminuria  >30        

(2) Blood tests were performed to determine the amount of creatinine and urea nitrogen index in renal function (renal filament filtration rate).

Kidney Filtration Rate               (eGFR ml/min/1.73m2)
¨ 90(Normal Renal Function)
¨60 ~ 89(Mild Renal Failure)
¨30 ~ 59(Moderate Renal Failure)
¨15 ~ 29(Severe Renal Failure)
¨< 15(End-Stage Renal Disease)

(3) Kidney ultrasonography to check whether kidneys are too large or have shrunk. (Examination process determined by the physician.)


三、Care for Diabetic Nephropathy
   
During the occurrence of albuminuria, you must actively receive treatment and care. Once the kidney is damaged, its function will never be able to go back to how it was and do a good job of daily health management. Receiving treatment is the best way to prevent and delay the decline of renal function.

(1) Good Blood Sugar Control
   Hyperglycemia can lead to microvascular and macrovascular disease, affecting renal blood flow, resulting in decreased renal function. Normal blood glucose before meals is 80-130 mg/dl, after meals is less than 160 mg/dl, with the glycosylated hemoglobin less than 7.0%.
(2) Strict Control of Blood Pressure
High and low blood pressure will accelerate the destruction of renal blood vessels, leading to deterioration of renal function. Ideal systolic blood pressure should be controlled to be under 140 mmHg, diastolic blood pressure below 90 mmHg; blood pressure in patients with proteinuria should maintain their systolic blood pressure below 130 mmHg; diastolic blood pressure below 80 mmHg.(3) Control Body Fat

Concentration of body fat is also one of the causes of renal dysfunction. Ideal amount of low-density cholesterol (LDL)is less than 100mg/dl and recommended amount of triglyceride (TG) is less than 150 mg/dl.
(4) Diet Adjustment:(a).Adjust protein intake, such as fish, meat, chicken, duck, eggs, milk, soy products. This can reduce albuminuria and slow down the deterioration of kidney function. (Recommend following advice designed by a dietician.)(b). Avoid fried and high fat foods such as: fatty meats, skin on meats, organs, dessert, and pastries. This is beneficial for maintaining normal blood fat concentration.(c). Maintain a light diet, one without too much high sodium foods, such as: pickled, canned, or processed foods, to help maintain blood pressure.

(5) Healthy Living Habits (a). Exercising regularly will help control blood pressure, blood sugar, and fat control. (b). Quit smoking, and you will have more control over high blood pressure and proteinuria.(c). Maintain the ideal weight and avoid excessive obesity, with a body mass index (BMI) between 18-24.(d). Don’t stay up all night, and don’t binge on alcohol.

(6) Prevent Infection: Common urinary tract and respiratory infections can affect kidney function. (a). Prevention of Urinary Tract Infections: When using the restroom, have good personal hygiene habits. Do not hold back urine, and shower instead of bathe. (b). Prevention of Respiratory Infections: Pay attention to the changes in temperature and add clothes when necessary. During influenza season, try not to go to public places. Furthermore, get the influenza vaccine every year around October to November to decrease the rate of getting sick.(7) Continue Outpatient Treatment and Tracking(a). Adhere to the doctor’s instructions on using medication, do not use medicine from someone else or take any unknown remedies or herbs. (b). Return regularly to see the doctor or nutritionist to get advice and guidance. (c). Diabetic patients should be tested annually for microalbuminuria and for blood creatinine to monitor renal function.

Self-Assessment (True/False)(0 )1. Early symptoms of diabetic nephropathy is the presence of microalbuminuria.( 0)2. Hyperglycemia can lead to vascular disease, resulting in decreased renal function.
(X )3. Diabetic nephropathy patients only have to control the intake of high sugar foods in their diet.

編碼:5736-單張-英文-126-02
英文翻譯日期:2017年6月
依據:5736-單張-中文-306-03
中文修訂日期:2017年3月

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