Koulouridis E
Nephrology Department, General Hospital of Corfu, Greece.
J Pediatr Endocrinol Metab. 2001;14 Suppl 5:1367-77.
Insulin dependent diabetes mellitus (IDDM) is a disease predominantly affecting children and young adults. Over the last few decades, there has been an increase in the number of patients with IDDM which has almost doubled the incidence per generation. Evidence suggests that autoimmunity plays an important role in its pathogenesis. Diabetic nephropathy is a serious complication of IDDM, affecting about one-third of patients. It is accompanied by generalized micro- and macroangiopathy, neuropathy and arterial hypertension. Diabetic nephropathy is characterized by a long evolution, starting from microalbuminuria and, over 10-20 years, leading to end stage renal failure (ESRD). Microalbuminuria in children is reversible and by no means necessitates evolution to ESRD. Conversely, overt albuminuria inevitably progresses to ESRD irrespective of any known treatment. The principal pathogenic factors of diabetic nephropathy are glucose metabolic derangement and genetic predisposition, but to date no definite candidate gene(s) have been established as predisposing to the disease. Once diabetic nephropathy is established, it carries a high risk of morbidity and mortality because of the concurrent occurrence of other functional abnormalities, some of them life-threatening. Hemodialysis, peritoneal dialysis and renal transplantation are effective treatments of ESRD due to diabetic nephropathy, but recurrence of the disease in the renal transplant is very common among patients with IDDM unless renal transplantation is accompanied bypancreatic transplantation.
胰岛素依赖型糖尿病（IDDM）是一种主要影响儿童和年轻人的疾病。在过去几十年中，IDDM患者数量有所增加，每代人的发病率几乎翻了一番。有证据表明，自身免疫在其发病机制中起重要作用。糖尿病肾病是IDDM的一种严重并发症，约三分之一的患者受其影响。它伴有全身性微血管和大血管病变、神经病变和动脉高血压。糖尿病肾病的特点是病程漫长，从微量白蛋白尿开始，经过10 - 20年，最终导致终末期肾衰竭（ESRD）。儿童微量白蛋白尿是可逆的，并不一定会发展为ESRD。相反，显性白蛋白尿无论采用何种已知治疗方法都会不可避免地进展为ESRD。糖尿病肾病的主要致病因素是糖代谢紊乱和遗传易感性，但迄今为止尚未确定导致该疾病的明确候选基因。一旦糖尿病肾病确诊，由于同时存在其他功能异常，其中一些危及生命，其发病和死亡风险很高。血液透析、腹膜透析和肾移植是治疗糖尿病肾病所致ESRD的有效方法，但在IDDM患者中，肾移植后疾病复发非常常见，除非肾移植同时进行胰腺移植。
