Advances in pathogenetic mechanisms of diabetic nephropathy.
Advances in pathogenetic mechanisms of diabetic nephropathy.
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发表时间：
2003-11
影响因子：
1.6
通讯作者：
S. Nicholas
中科院分区：
文献类型：
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作者：
S. Nicholas
世界各地正在经历的糖尿病流行带来了许多影响。由于糖尿病是美国和西方世界终末期肾病的最常见原因，因此我们预计患病率将继续上升。少数糖尿病患者患糖尿病肾病的发病率异常高，导致终末期肾病。数据表明积极的医疗管理应该是他们的主要治疗方法。在过去的五年中，我们对糖尿病肾小球硬化病理机制的了解已经大大扩展。转化生长因子（TGF）-β 在发病机制中仍然发挥着关键作用。然而，现在已经描述了许多信号机制。此外，TGF-β还可能损害肾小球上皮细胞或足细胞，导致足细胞尿和蛋白尿，并随着进行性糖尿病肾病而恶化。此外，糖尿病中 TGF-β 的上调可能会导致肾小管上皮细胞损伤或转化，从而导致间质纤维化。噻唑烷二酮类药物在 2 型糖尿病中的使用与胰岛素敏感性的改善以及白蛋白尿的改善有关。这些配体发挥作用的机制尚不清楚，但可能有几个靶标，包括系膜细胞和足细胞。
The diabetic epidemic that is being experienced around the world has many ramifications. Since diabetes is the most common cause of end stage renal disease in the United States and the Western world, we can expect the increase in prevalence to continue. Minority individuals with diabetes suffer a disproportionately high incidence of diabetic nephropathy leading to end stage renal disease. The data suggest that aggressive medical management should be their mainstay of therapy. In the past five years, our knowledge of the mechanisms involved in the pathology of diabetic glomerulosclerosis has greatly expanded. Transforming growth factor (TGF)-beta still maintains a key role in the pathogenesis. However, many of the signaling mechanisms have now been described. Furthermore, TGF-beta may also function to damage glomerular epithelial cells or podocytes, resulting in podocyteuria and proteinuria that worsen with progressive diabetic nephropathy. Additionally, TGF-beta upregulation in diabetes may cause injury or transformation of tubular epithelial cells that contribute to interstitial fibrosis. The use of thiazolidinediones in type 2 diabetes is associated with improvement in insulin sensitivity, as well as improvement in albuminuria. The mechanisms by which these ligands function remain unclear, but there may be several targets that could include mesangial cells and podocytes.