Hostetter Thomas H
National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health, Bethesda, Maryland, USA.
J Am Soc Nephrol. 2003 Jul;14(7 Suppl 2):S144-7. doi: 10.1097/01.asn.0000070150.60928.06.
Prevention of the major causes of ESRD, hypertension, and diabetes, is possible. Careful glycemic control can prevent diabetes nephropathy. BP control can likely prevent the large majority of hypertensive renal disease. Testing for diabetic renal disease is well founded. In contrast, screening for hypertensive kidney disease is less well defined. Most established renal disease can be treated with glycemic control in the case of diabetes, BP treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and dietary protein restriction. Other therapeutic targets have been proposed, but are not well established. Future research should focus on defining the high risk patients, developing better markers of risk, and designing additional therapies.
预防终末期肾病（ESRD）的主要病因——高血压和糖尿病是有可能的。严格控制血糖可预防糖尿病肾病。控制血压很可能预防绝大多数高血压性肾病。对糖尿病肾病进行检测是有充分依据的。相比之下，对高血压性肾病的筛查则不太明确。在糖尿病方面，大多数已确诊的肾病可通过控制血糖来治疗；对于高血压，则使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂进行血压治疗，并限制饮食中的蛋白质摄入。虽然有人提出了其他治疗靶点，但尚未得到充分确立。未来的研究应集中于确定高危患者、开发更好的风险标志物以及设计更多的治疗方法。
