González M T, Castell C, Esmatjes E, Tresserras R, de Lara N, Lloveras G
Societat Catalana de Nefrología, Barcelona.
Rev Clin Esp. 1999 Jan;199(1):8-12.
The appearance of diabetic nephropathy and its progression towards renal failure can be prevented if an early treatment is instituted. However, diabetes is currently one of the main causes of entry into a dialysis program. Therefore, the diagnostic characteristics of renal disease in 105 patients who started dialysis in Catalonia in 1994 were reviewed; the presence of other changes associated with diabetes were assessed. The results showed that 81.7% of patients had proteinuria higher than 0.5 g/24 h, and 40.5% had plasma creatinine higher than 5 mg/dl at the first nephrological control. As a result, the period between diagnosis of nephropathy and the inclusion in the dialysis program was very short (3.7 years) and considerably shorter than that reflected in literature for other countries, whereas the incidence of other micro and macrovascular complications was similar. Remarkably, a high number of smokers and treatment with oral antidiabetic drugs (33%) at the end stage of renal failure was observed. These results suggest that follow-up of diabetics should be more exhaustive and serial tests be performed to detect nephropathy early. An appropriate control during renal failure stage can also postpone the disease progression and avoid the appearance of complications which at present have a high morbid-mortality and high cost.
如果能早期进行治疗，糖尿病肾病的出现及其向肾衰竭的进展是可以预防的。然而，糖尿病目前是进入透析治疗项目的主要原因之一。因此，我们回顾了1994年在加泰罗尼亚开始透析的105例患者的肾病诊断特征；评估了与糖尿病相关的其他变化的存在情况。结果显示，在首次肾病检查时，81.7%的患者蛋白尿高于0.5 g/24小时，40.5%的患者血浆肌酐高于5 mg/dl。因此，从肾病诊断到纳入透析治疗项目的时间间隔非常短（3.7年），比其他国家文献报道的要短得多，而其他微血管和大血管并发症的发生率相似。值得注意的是，在肾衰竭末期观察到大量吸烟者以及使用口服降糖药治疗的患者（33%）。这些结果表明，对糖尿病患者的随访应该更加详尽，并进行系列检查以早期发现肾病。在肾衰竭阶段进行适当的控制也可以延缓疾病进展，避免出现目前具有高病残率和高死亡率且成本高昂的并发症。
