Particularly prevalent in the course of diabetic nephropathy over 10 years with diabetes, proteinuria is the earliest manifestations of diabetic nephropathy, the pathogenesis is very complex and not yet fully clarified. Studies showed that the pathogenesis of diabetic nephropathy is multifactorial, mainly in the following areas:
1, renal hemodynamic abnormalities
In diabetic nephropathy, played a key role, perhaps even start moving factors. (1) high blood sugar, the glomeruli of high perfusion, high filtration state, increased pressure across capillary walls, so that the expansion of mesangial cells, epithelial cell foot process fusion and produce dense droplets, glomerular epithelial cells from the basement membrane shedding. (2) The glomerular basement membrane of type Ⅳ collagen messenger-RNA higher, so that basement membrane thickening and eventually the formation of mesangial diffuse, nodular lesions, glomerular sclerosis occurs. (3) In the case of increased pressure, protein filtration increase, can also be deposited in the mesangial area and glomerular basement membrane, promoting stromal proliferation, creating a vicious circle, and can result in nodular and diffuse glomerulosclerosis .
Of diabetic nephropathy and high blood glucose is closely related to poor blood glucose control can accelerate the development of diabetic nephropathy, good blood glucose control can significantly slow down its development. High blood sugar and advanced glycation end products generated after the rise to an increase in mesangial cell proliferation, increased extracellular matrix, mesangial expansion, glomerular basement membrane thickening and so on.
3, genetic factors
The majority of diabetic kidney disease in patients with end-does not occur, a number of long-term good glycemic control in patients with diabetic nephropathy also can occur. Glucose transporter protein -1 (GLUT1) is a glomerular mesangial cells, the major glucose transporter. Recent studies have found that different individuals with diabetes GLUT1 in mesangial cells and regulation of the menu up to the difference may be susceptible to kidney damage in some patients one of the factors. And the incidence of diabetic nephropathy also demonstrated the phenomenon of the family gathered, in some family history of diabetes, high blood pressure patients, the incidence of diabetic nephropathy was significantly higher than patients with no family history of hypertension. In addition, diabetic nephropathy among different ethnic groups there are also differences in the incidence. This showed that both the incidence of diabetic nephropathy and genetic factors.
4, high blood pressure
And diabetic nephropathy is not directly related, but the original course of middle to high blood pressure or microalbuminuria, after periods of elevated blood pressure can accelerate the progress of diabetic nephropathy and renal function deterioration, increased urinary albumin excretion.