Renal diabetes is organ dysfunction leading to dehydration and disturbance of the water-salt balance. The disease is well treatable, but can lead to complications. Diabetes is a disease that many people have at least some idea of. Basically, the information relates to how to prevent this serious illness. This means only one form of diabetes. In practice, there are several different diseases associated with impaired absorption and use of sugars. One of them is renal diabetes.
Kidney Diabetes
The most important functions of the body are excretory, that is, the ability of the kidney to remove from the blood the final products of metabolism, excess water, minerals in the form of a solution of creatinine, uric acid, phenols, amines and other. If this function is violated, the substances to be removed accumulate and return back to the blood, gradually poisoning the entire body, and not just the kidney itself.
An important feature of the kidneys is the ability to concentrate and dilute urine depending on the needs of the body. It is because of this that the concentration of various substances and the amount of fluid varies considerably depending on the time of the day, the work performed, the body temperature and so on. Obviously, failure to perform this function leads to various types of intoxication.
The variety of diseases associated with suppression of the excretory function is due to the fact that absorption and removal are most often disturbed in relation to a certain substance. It is to this type of ailments that kidney diabetes relates.
Symptoms of the disease are manifested only at a severe stage, when the loss of glucose and water becomes very significant. In a mild form, the level of glucose in the blood remains normal, the tolerance to the load is normal or low, that is, on the absorption of glucose from the food the ailment does not affect. Sometimes renal diabetes "neighbors" with sugar. Diseases are related, but indirectly, rather, affect the development of each other than provoke.
The main danger is the loss of fluid and developing hypokalemia, which, in the end, leads to the destruction of the water-salt balance. In addition, a deficiency of carbohydrates does not allow maintaining a normal energy balance.
The disease does not apply to common, but it can be congenital - an autosomal dominant type of inheritance. By age and sex, the ailment is not "tied."
In children, the congenital form shows already at 3-6 weeks of life. A characteristic feature - a baby prefers water to mother's milk and quickly loses weight. The neural form, as well as the adult, has a blurred symptomatology, although its consequences are much more destructive. Often, the disease is determined even when the child begins to lag behind in physical and mental development.
Relatively easy stabilized form to deviations in development does not result. Adult patients can not guess about their illness for decades.
Causes of
If the mechanisms of the disease itself are sufficiently well studied, then the causes are not exactly established.
The existing theories explain the violation of glucose transport in the following way:
- In renal glucosuria, type A decreases the mass of proximal tubules relative to their surface, which leads to loss of glucose.
- Dysfunction of the transport system itself against the concentration gradient in the membrane. The proof is that the transition of glucose through the membrane is associated with sodium transport. Washing out of the latter, respectively, leads to the excretion of sugar.
- Reducing the permeability of those membranes that are facing the lumen of the tubules - glucose is not retained by the membrane.
- Decreased functionality of the membrane carrier itself for glucose.
Another form( diabetes insipidus) - salt diabetes - is related to renal diabetes. It is associated with violations of sodium absorption, which leads to its elimination and the development of hyponatremia, that is, again to the violation of the water-salt balance.
The causes of this disease are better studied:
- Infectious diseases like tuberculosis, influenza.
- The pathology of the hypothalamus, leading to failure in the synthesis of antidiuretic hormone - vasopressin. Can have an innate or acquired nature.
- Damage to the brain, one way or another affecting the function of urination - trauma, tumor, surgery.
- Autoimmune diseases in which the calcium system is attacked.
On the video about the causes of diabetes insipidus:
Types
There are two bases of the form of the disease: sugar and salt kidney diabetes. Despite the fact that the ailments are of the same type, the differences between them are significant.
Sugar
Sugar - glycosuria, that is, insufficient reabsorption of glucose, which leads to its excretion in the urine. Against the background of diabetes, the disease is practically not identified, since this mechanism - the output of glucose, is compensating for high blood sugar. However, this violation, nevertheless, leads to a faster deterioration of the nephrons, since they work with excessive load.
There are two subspecies:
- type A - associated with loss of anatomical mass of proximal tubules;
- type B - violation of sugar transport is observed only in some nephrons, while the other part works with increased load.
In relation to the mechanism of formation of the disease, renal glucosuria is divided into primary and secondary:
- primary - is associated with congenital dysfunction of the tubular system;
- secondary is a consequence of acquired pathologies. These include nephrosis, glomerulonephritis, Girke's disease and so on.
In addition, renal and adrenal glucosuria are considered:
- Renal form - is associated with impaired glucose uptake at the level of the kidney, in the tubular system, and due to the disorder of glucose transport in cells.
- The extrarenal is formed under the influence of external factors. It differs from kidney in that the increase in glucose level in urine coincides with the increase in sugar in the blood.
There are several subspecies associated with the cause of the disorders:
- diabetic - is associated with diabetes, usually of the first type. Sugar in the urine appears even with a slight excess of the indices in the blood plasma. The absence of glucose in the urine is a sign of extremely negative, since it indicates an inability of the body to filter anything at all;
- central - is associated with brain damage. It is caused by encephalitis, meningitis, stroke, hemorrhage with trauma and so on;
- pancreatic - is temporary, provokes an ailment in the pancreas. After removal of the inflammation, the glucosuria disappears;
- endocrine - is associated with an excess or lack of hormones. The cause can serve as a primary disease - pheochromocytoma, acromegaly, and the use of medications - ACTH, cortisol and others;
- hyperthermia is also a temporary condition caused by fever, which leads to dehydration and hypokalemia.
Consider such subspecies:
- alimentary - is the result of eating with an excessive amount of carbohydrates. It is observed 30 minutes after eating and disappears after 4-5 hours. May be a consequence of taking glucocorticoids;
- emotional - is associated with a strong experience as a result of injuries, shock, blood loss. Also associated with glucocorticoids, but only of natural origin: the hormone is produced when the body adapts to a stressful condition;
- Glucosuria in pregnancy - usually formed on the third semester and after delivery disappears. If the sugar level in the urine is small, no special measures are taken. If the glucose level rises noticeably and is observed systematically, treatment is necessary.
Salt
The water-salt balance in the body is mostly provided by a certain ratio of sodium and potassium ions. The balance is maintained due to the work of the kidneys and the hormonal system. For example, with an increase in the concentration of sodium in the blood, hormone production in the adrenal glands is suspended, and sodium ions are excreted in the urine in order to restore the normal ratio of potassium and sodium. With a decrease in the concentration of sodium, aldosterone is actively synthesized.
Sodium is reabsorbed in the renal tubules. Aldosterone affects mineralocorticoid receptors, which, in turn, stimulate the production of sodium transport. The latter is excreted through the lumen of the tubule and is removed with urine.
Non-malignant salt renal diabetes appears when the sensitivity to aldosterone of the renal tubules is reduced. Accordingly, the body is not able to adequately respond to the concentration of aldosterone. As a result, sodium continues to be excreted, its concentration in the urine increases markedly - by 15-20 times.
Such a strong decrease in sodium ions leads to a significant loss of fluid, a violation of the water-salt balance and is the cause of severe pathologies. On this basis - dehydration of the body, salt diabetes and combine with sugar.
Distinguish congenital and acquired diabetes:
- congenital - is associated with pathologies in the development of the tubular system, is detected at the earliest age;
- acquired - appears due to infectious diseases - tuberculosis, brain damage - meningitis, trauma, vascular injuries and so on. The mechanism can be associated with both aldosterone and vasopressin.
If diabetes is associated with impaired development of an antidiuretic hormone, then it can be formed by two mechanisms.
Accordingly, there are 2 types of ailment:
- central - is associated with the absence of an antidiuretic hormone, which for some reason is not produced in the hypothalamus. In this case, water is not absorbed, since the kidneys do not receive the appropriate signal;
- nephrogenic diabetes insipidus is associated with a loss of sensitivity of the receptors in the cells of the renal tubules. Vasopressin is synthesized, but the organ does not respond to it.
Insufficient diabetes salt is more often found in young patients - up to 30 years. In the absence of treatment, the disease develops rapidly.
In children, the disease manifests itself sharply, sometimes in the form of seizures. Common symptoms are accompanied by fever, seizures.
Symptoms and signs
The clinical picture of diabetes depends on the severity, the cause of the disease and its nature. Unites their dehydration and developing on this background a strong thirst and excessive allocation of urine.
Sugar
The possibility of renal tubules to excrete certain substances, as a rule, is limited. So, for glucose the norm in the blood is 8,9-10 mmol / l. If this concentration is observed, glucose is reabsorbed and returned to the blood.
If this level is exceeded, the load on the tubules is excessive, and excess glucose is output. The value at which glucose ceases to be fully absorbed is called the "renal threshold."For different people the value of the critical concentration differs, but in the specified range, it usually fits.
In pregnant women, the threshold in the third semester decreases, which in most cases causes the appearance of sugar in the urine.
In a child, the "renal threshold" is 10.45-12, 65 mmol / l.
- The physiological norm for the concentration of glucose in urine is a value of 1.7 mmol / l. If the level is exceeded in more than 2.8 mmol / l, you can confidently talk about the disease.
No mild symptoms. In young children, there may be some weight loss, or rather, shortage of weight, reduced appetite.
Clinical signs appear only with severe dehydration and significant loss of glucose:
- weakness and dizziness;
- hunger, often combined with a lack of appetite - there is a desire, but "a piece of the throat does not climb";
- memory impairment, mental decline associated with starvation of the brain;
- polyuria - 3-4 liters per day.
These signs coincide with the symptoms of hypoglycemia, which makes diagnosis difficult.
- More clearly on the disease indicates excessive and frequent urination - polyuria, manifested in severe form and severe renal dysfunction.
Salt
Violation of water-salt balance is too important for normal life, therefore, its change affects well-being very quickly.
The main symptoms are as follows:
- polyuria - and to a large extent, 5-20 liters;
- is a constant thirst, as the body tries to restore the resource;
- may be incontinence, especially at night. Under the influence of such a load, the bladder increases and works with difficulty;
- weight loss - especially this symptom is manifested in children;
- dry skin, impaired salivation;
- febrile state;
- nausea before vomiting, hunger attacks amid a lack of appetite, constipation.
Symptoms develop gradually, but in the absence of treatment progress fairly quickly. In addition, such a load quickly affects the activity of the heart, which leads to an increase in blood pressure.
In young children, the symptoms are much more acute:
- A distinctive symptom of the disease is a very high sodium content in urine - 15-20 times higher than normal. To determine it, a biochemical blood test is performed to exclude acute renal failure.
- Also a characteristic symptom of renal insipid diabetes with its central form is a low level of antidiuretic hormone - vasopressin. The hormone accumulates in the posterior lobe of the pituitary gland and is removed as needed. With brain damage, autoimmune diseases or hypothalamic dysfunction, vasopressin is not synthesized in the required amount. As a result, the mechanism of the reverse absorption of water is destroyed, which leads to polyuria.
Check the level of vasopressin production with the help of the dry-eating test.
Diagnosis
It is important to conduct a differential examination to establish the correct diagnosis. Even with complete coincidence of symptoms, ailments can have different nature and cause.
To do this, assign a variety of different analyzes:
- First of all, the density and osmolarity of urine is determined - this is a common common analysis.
- Biochemical blood analysis and urinalysis allows you to determine the level of potassium, sodium and other elements and their ratio in plasma and urine.
- If you suspect a glucosuria, a blood and urine sample for sugar is analyzed. But if the test for glucose tolerance shows a relatively objective result, then the sugar level in urine has to be measured several times. Stresses, physical activity, the composition of a recent lunch - all this affects the excretion of glucose. Based on a single urine test for glucose, you can not make a diagnosis.
- If you suspect a salt form of diabetes against the background of the lack of an antidiuretic hormone, test the dryness. The patient does not drink water under the supervision of a doctor for 8-24 hours. Each hour, urine is taken for analysis: the density of osmotic pressure and the level of sodium in urine is determined. The patient is constantly weighed. The test is completed after the due time, or if the patient has lost more than 5% of the weight, the level of sodium in the urine has reached 3 mmol / l or more, and the density and osmolality remain at a low level.
This test result confirms the salt renal diabetes of the central type, that is, in the absence of vasopressin.
If the results are different, then further diffodiagnosis is performed taking into account the possibility of nervous or mental polydipsia:
- The second test, which allows to separate salt diabetes - examination using minirin. The sample is run through Zimnitsky before and after the drug. If the drug is effective, that is, the density of urine rises, and its volume decreases after intake, then it is possible to diagnose hypothalamic diabetes safely.
- Biochemical blood test in this case is crucial: the level of vasopressin in the blood is divided into central and nephrogenic diabetes. In the first case, the level of vasopressin is lowered, in the second - is overestimated.
Other tests may also be prescribed:
- MRI - to exclude tumors in the brain that put pressure on the hypothalamus;
- biopsy of the renal parenchyma - in case of salt diabetes, there are no morphological changes, unlike OPN.
On the video about the treatment of diabetes insipidus:
Treatment of
The mechanism of formation of sugar and salt diabetes is very different. Treatment, in fact, has nothing to do.
With glucosuria
Sugar renal diabetes is almost never an independent disease. Often the course of therapy is reduced to the treatment of the primary primary disease - endocrine disorders, pancreatitis and so on.
In the mild form of glucosuria, no treatment is required, but the level of glucose in the urine needs to be monitored.
In severe cases, resort to medical treatment. The goal is to lower the glucose level to normal.
For this apply:
- ACE inhibitors, decreasing blood pressure - quinapril, captopril;
- angiotensin-2 receptor blockers - valsartan, condesartan. They are prescribed if ACE inhibitors are contraindicated for some reason;
- sulodexide is a drug that restores the normal level of the basement membrane permeability.
Glucosuria requires a certain diet, often recommended for diabetics, but not in such a severe form.
Diabetes salt
The therapeutic course for salt diabetes is aimed at restoring the water-salt balance. In fact, to restore the level of sodium in the blood. For this, a sodium solution is introduced in order to achieve the required concentration.
The rest of the treatment depends on the diagnosis:
- In the treatment of central type diabetes, drugs that are an artificial analogue of vasopressin are used: desmopressin, minirin, adiuretin.
- In nephrogenic type of diabetes, desmopressin is ineffective. For treatment, prostaglandin inhibitors are prescribed: ibuprofen, aspirin, indomethacin. The basis of the course are thiazide diuretics.
The diet is basically reduced to limiting or even excluding salt. For the period of treatment and recovery, the basis of the diet should be fruits, vegetables and dairy products. Drinking mode is not limited.
Treatment of children is not much different. The basis is substitution therapy with analogues of antidiuretic hormone. Usually, this is desmopressin.
The dose and regimen are determined by the physician based on the patient's condition. There are no general recommendations here.
On the video about the treatment of diabetes:
Forecasts and complications of
The prognosis for patients with renal diabetes is favorable, even with late referral to a doctor. Glucosuria, in principle, is not life-threatening ailment, although it can intensify the development of diabetes mellitus.
Saline kidney diabetes is also quite easily cured when the underlying disease is eliminated.
When treating children, it is important to determine the disease in time, because its severe forms lead to a developmental lag. Forecasts are nevertheless favorable. However, when making such a diagnosis, children should be under clinical observation: once in 3 months, dry skin, thirst, diuresis are evaluated, physical and mental development is monitored. Necessary to visit a neurologist and oculist.
Renal diabetes is a disease that is well treatable and does not require a cardinal revision of a lifestyle. However, the recommendations of a doctor and a nutritionist nevertheless must be followed.