Current Challenges and Future Perspectives of Renal Tubular Dysfunction in Diabetic Kidney Disease.
Current Challenges and Future Perspectives of Renal Tubular Dysfunction in Diabetic Kidney Disease.
复制标题
糖尿病肾病肾小管功能障碍的当前挑战和未来前景
DOI：
10.3389/fendo.2021.661185
复制
发表时间：
2021
影响因子：
5.2
通讯作者：
Yuan Y
中科院分区：
文献类型：
--
作者：
Duan S;Lu F;Song D;Zhang C;Zhang B;Xing C;Yuan Y
近几十年来，人们对糖尿病肾病（DKD）蛋白尿的发病机制、DKD筛查、诊断和预后的生物标志物以及新型降血糖药物的临床研究取得了很大进展，肾小管在DKD中的作用受到了越来越多的关注。既往研究表明，肾小管的形态和功能改变与DKD的发生、发展密切相关。新的肾小管生物标志物已显示出一定的临床重要性。然而，在临床实践中过渡到个性化诊断和个体治疗指导存在许多挑战。大规模临床试验表明，钠-葡萄糖协同转运蛋白2（SGLT-2）增加近端重吸收和超滤与改善糖尿病患者肾脏结局的临床相关性，进一步促进了肾小管中心研究的出现。本文就DKD的肾小管病理生理机制、潜在的肾小管生物标志物及其临床应用、DKD治疗中的肾小管因素等方面的研究进展作一综述。总结和讨论了SGLT 2抑制剂的肾脏保护机制和令人印象深刻的临床试验结果，提供了针对肾小管的治疗策略的全面更新。
Over decades, substantial progress has been achieved in understanding the pathogenesis of proteinuria in diabetic kidney disease (DKD), biomarkers for DKD screening, diagnosis, and prognosis, as well as novel hypoglycemia agents in clinical trials, thereby rendering more attention focused on the role of renal tubules in DKD. Previous studies have demonstrated that morphological and functional changes in renal tubules are highly involved in the occurrence and development of DKD. Novel tubular biomarkers have shown some clinical importance. However, there are many challenges to transition into personalized diagnosis and guidance for individual therapy in clinical practice. Large-scale clinical trials suggested the clinical relevance of increased proximal reabsorption and hyperfiltration by sodium-glucose cotransporter-2 (SGLT2) to improve renal outcomes in patients with diabetes, further promoting the emergence of renal tubulocentric research. Therefore, this review summarized the recent progress in the pathophysiology associated with involved mechanisms of renal tubules, potential tubular biomarkers with clinical application, and renal tubular factors in DKD management. The mechanism of kidney protection and impressive results from clinical trials of SGLT2 inhibitors were summarized and discussed, offering a comprehensive update on therapeutic strategies targeting renal tubules.
登录
查看更多内容
影响因子：
13.6
作者：
Amsellem, Sabine;Gburek, Jakub;Kozyraki, Renata
通讯作者：
Kozyraki, Renata
影响因子：
8.2
作者：
Buse, John B.;Wexler, Deborah J.;Davies, Melanie J.
通讯作者：
Davies, Melanie J.
DOI：
10.1152/ajprenal.00210.2018
发表时间：
2018-11-01
影响因子：
4.2
作者：
Bryniarski, Mark A.;Yee, Benjamin M.;Morris, Marilyn E.
通讯作者：
Morris, Marilyn E.
影响因子：
19.6
作者：
通讯作者：
--
DOI：
10.1053/j.ajkd.2020.07.011
发表时间：
2021-01
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Anderson AH;Xie D;Wang X;Baudier RL;Orlandi P;Appel LJ;Dember LM;He J;Kusek JW;Lash JP;Navaneethan SD;Ojo A;Rahman M;Roy J;Scialla JJ;Sondheimer JH;Steigerwalt SP;Wilson FP;Wolf M;Feldman HI;CRIC Study Investigators
通讯作者：
CRIC Study Investigators