URINAL INFECTIONS

The urinal infections happen with more frequency in the diabetics than in the general population. This disparity is more apparent than real, due, in certain way, to the frequency with which the diabetics realize urine analysis. The infections are often serious.

Due to the risk of serious infections, it is necessary only to realize a poll vesical to diabetics when there exist reasons that justify it.

The treatment is the conventional one, although it is necessary that it lasts more to achieve the finished healing. It is fundamental to realize frequent examinations to detect relapsing and recurrencias.

DIABETIC NEFROPATÍA

Due to the alterations that take place in the renal structure in the diabetic patients, the function sewage treatment plant of the blood that carries out this organ they are deteriorating of progressive form, producing a constant increase of the numbers of urea in blood and a progressive loss of proteins across the urine. This gives place to a hipoalbuminemia, or decrease of proteins and the consequent appearance of edemas (retention of liquids). After a period of years, the finished clinical picture appears, with hypertension, important peripheral edemas and uremia (increase of the urea in blood). Some complications, like the infarction of myocardium, the heart failure, the cerebral accidents, the neuropathy (injuries in peripheral nerves) and the peripheral vascular illness (to see arterioesclerosis of the extremities), they aggravate the problem.

The elimination of albumin in the urine is one of the fundamental signs that is going to allow to predict the grade of renal injury to us.

Major all that is the valuation of excretion of albumin, major value takes clinic as a factor predictivo of the later appearance of nefropatía, whenever there are excluded other causes that can provoke it (bad control of the diabetes, hypertension, infections, exercise)

The nefropatía predominance in the diabetics insulino dependent increases with the duration of the illness. It shows a predominance of the masculine sex.

45 % of all the patients with DMID develops nefropatía clinic.

The diabetic nefropatía is a serious complication and it is the cause of death of 25 % of all the DMID.

During the first years of DMID it is possible to find microalbuminuria (albumin in urine only detectable by means of specific analysis) if it is looked. After 15 years there appears the macroalbuminuria (detectable albumin by means of a normal urine analysis), which at first can be a flashing signal and/or provoked by the exercise. Later, the albuminuria is persistent and she increases of intensity.

The patients with a proteinuria of late appearance showed a survival lower than that of the patients with proteinuria of precocious appearance, what can reflect a heterogeneity of the diabetic nefropatía.

The renal function can remain normal for years and, later, it begins diminishing.

The absence of other diabetic complications, especially of the retinopatía, suggests that the diabetes cannot be the cause of the renal insufficiency.

The strict control of the DM and of the hypertension can enlentecer the inevitable progression towards the terminal renal insufficiency. The insulin requests diminish, because also it diminishes the catabolismo (metabolic elimination) renal of the insulin. In the patients treated with antidiabetic oral, these medicines must be replaced with insulin when the renal insufficiency appears, to avoid the accumulation phenomena.

As soon as the renal insufficiency was established, the election is located between the dialysis and the transplant.

• Hemodiálisis

For some patients the hemodiálisis will be used like temporary treatment, while in others it is the treatment of election or that of reservation (in case it trumps the dialysis peritoneal).

• Transplant

The transplant must be the first election, especially in young patients, and must be realized as soon as the creatinina aclaramiento falls down below 15 ml min.

The quality of life after a transplant successfully is very superior to that of any other treatment, although the retinopatía, the central or peripheral vascular problems and the amputations can produce a considerable mortality.

The selection of the suitable cases is of big importance, especially because the donors are scarce. The valuation of survival of the graft at the age of 2 changes of 80 %, when the donor is a living relative of the recipient, 40 % when it is a question of a transplant of corpse.

In the transplanted kidney the typical histological injuries appear, but up to the date there is no documented history of renal insufficiency of the kidney grafted for nefropatía diabetic.

The patients most adapted for the transplant are the persons younger than 40 years with good vision and with light neuropathy, cardiovascular disease and peripheral vascular illness.

TO SEE ALSO

• Arterioesclerosis of the Extremities
• Diabetes Mellitus
• Complications of the Diabetes
• Pregnancy and Diabetes
• Hypoglycemia. Reaction to the Insulin
• Injection of Insulin
• Diabetic foot
• Diabetic Retinopatía
• Treatment of the Diabetes

WHAT DOCTOR CAN TREAT ME?

Select a province A Coruna Alava Albacete Alicante Almeria Asturias Avila Badajoz Barcelona Burgos Caceres Cadiz Cantabria Castellón Ciudad Real Cordova Cuenca Gipúzcoa Girona Granada Guadalajara Huelva Huesca Illes Balears Jaen La Rioja Las Palmas León Lleida Lugo Madrid Malaga Murcia Navarre Ourense Palencia Pontevedra Salamanca Santa Cruz Tenerife Segovia Seville Soria Tarragona Teruel Toledo Valencia Valladolid Biscay Zamora Saragossa

Service offered for