Diabetic nephropathy.
Diabetic nephropathy.
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DOI：
10.1186/1758-5996-1-10
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发表时间：
2009-09-21
影响因子：
4.8
通讯作者：
Canani LH
中科院分区：
文献类型：
--
作者：
Zelmanovitz T;Gerchman F;Balthazar AP;Thomazelli FC;Matos JD;Canani LH
糖尿病肾病是慢性肾脏疾病的主要原因，也是心血管死亡的主要原因。糖尿病肾病分为两个阶段：微量白蛋白尿和大量白蛋白尿。微量白蛋白尿和大量白蛋白尿的临界值是任意的，其值受到质疑。白蛋白尿正常范围上限的受试者进展为微量白蛋白尿或大量白蛋白尿的风险较高，并且他们的血压也高于正常白蛋白尿范围下限的正常白蛋白尿受试者。糖尿病肾病的筛查是通过测量点尿中的白蛋白来进行的。如果异常，则应在3至6个月间隔内采集的3份样本中的2份中进行确认。此外，建议常规估计肾小球滤过率以进行适当的肾病筛查，因为当尿白蛋白值在正常范围内时，一些患者会出现肾小球滤过率降低。糖尿病肾病的两个主要危险因素是高血糖和动脉高血压，但1型和2型糖尿病的遗传易感性是非常重要的。其他危险因素包括吸烟、血脂异常、蛋白尿、肾小球高滤过和饮食因素。肾病在1型糖尿病患者中的病理特征为肾小球和肾小管基底膜增厚，伴有进行性系膜扩张（弥漫性或结节性），导致肾小球滤过表面进行性减少。同时间质形态学改变和玻璃样变的传入和传出肾小球小动脉也发生。足细胞异常似乎也参与肾小球硬化过程。在2型糖尿病患者中，肾脏病变是异质性的，比1型糖尿病患者更复杂。糖尿病肾病的治疗基于多风险因素方法，目标是延缓疾病的发展或进展，并降低受试者增加的心血管疾病风险。实现最佳代谢控制，治疗高血压（<130/80 mmHg）和血脂异常（LDL胆固醇<100 mg/dl），使用阻断肾素-血管紧张素-醛固酮系统的药物，是预防微量白蛋白尿发展，延缓肾病进展到更晚期和降低糖尿病患者心血管死亡率的有效策略。
Diabetic nephropathy is the leading cause of chronic renal disease and a major cause of cardiovascular mortality. Diabetic nephropathy has been categorized into stages: microalbuminuria and macroalbuminuria. The cut-off values of micro- and macroalbuminuria are arbitrary and their values have been questioned. Subjects in the upper-normal range of albuminuria seem to be at high risk of progression to micro- or macroalbuminuria and they also had a higher blood pressure than normoalbuminuric subjects in the lower normoalbuminuria range. Diabetic nephropathy screening is made by measuring albumin in spot urine. If abnormal, it should be confirmed in two out three samples collected in a three to six-months interval. Additionally, it is recommended that glomerular filtration rate be routinely estimated for appropriate screening of nephropathy, because some patients present a decreased glomerular filtration rate when urine albumin values are in the normal range. The two main risk factors for diabetic nephropathy are hyperglycemia and arterial hypertension, but the genetic susceptibility in both type 1 and type 2 diabetes is of great importance. Other risk factors are smoking, dyslipidemia, proteinuria, glomerular hyperfiltration and dietary factors. Nephropathy is pathologically characterized in individuals with type 1 diabetes by thickening of glomerular and tubular basal membranes, with progressive mesangial expansion (diffuse or nodular) leading to progressive reduction of glomerular filtration surface. Concurrent interstitial morphological alterations and hyalinization of afferent and efferent glomerular arterioles also occur. Podocytes abnormalities also appear to be involved in the glomerulosclerosis process. In patients with type 2 diabetes, renal lesions are heterogeneous and more complex than in individuals with type 1 diabetes. Treatment of diabetic nephropathy is based on a multiple risk factor approach, and the goal is retarding the development or progression of the disease and to decrease the subject's increased risk of cardiovascular disease. Achieving the best metabolic control, treating hypertension (<130/80 mmHg) and dyslipidemia (LDL cholesterol <100 mg/dl), using drugs that block the renin-angiotensin-aldosterone system, are effective strategies for preventing the development of microalbuminuria, delaying the progression to more advanced stages of nephropathy and reducing cardiovascular mortality in patients with diabetes.
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影响因子：
13.2
作者：
Bakris, GL;Williams, M;Sowers, J
通讯作者：
Sowers, J
影响因子：
7.7
作者：
Canani, LH;Gerchman, F;Gross, JL
通讯作者：
Gross, JL
影响因子：
7.7
作者：
Caramori, ML;Fioretto, P;Mauer, M
通讯作者：
Mauer, M
糖尿病的医疗标准 - 2009年。
影响因子：
16.2
作者：
American Diabetes Association
通讯作者：
American Diabetes Association
对糖尿病性肾病中纤维化和硬化症机制的新见解。
影响因子：
8.2
作者：
Brosius, Frank C., III
通讯作者：
Brosius, Frank C., III