Sugimoto Taro, Nakamura Yoshio, Makino Hirofumi
Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry.
Nihon Rinsho. 2003 Jul;61(7):1167-71.
Diabetic nephropathy is the most important cause of end-stage renal failure. Recent clinical trials have postulated the possibility for prevention and remission of the disease once reckoned as irreversible. In DCCT, UKPDS and Kumamoto study, progression to overt proteinuria was prevented by intensive blood glucose control. Lewis study has demonstrated renoprotective effect of ACE inhibitor in type-1 diabetic nephropathy, and RENAAL and IDNT has documented that of angiotensin II type-1 receptor blocker in type-2 diabetes. Moreover, potential efficacy of lipid lowering in prevention of diabetic nephropathy has been postulated in recent Steno-2, multifactorial intervention trial. Thus, simultaneous adjustment on hyperglycemia, hypertension, and dyslipidemia may lead to prevention and remission of diabetic nephropathy.
糖尿病肾病是终末期肾衰竭的最重要原因。近期临床试验推测，这种曾被认为不可逆转的疾病有可能得到预防和缓解。在糖尿病控制与并发症试验（DCCT）、英国前瞻性糖尿病研究（UKPDS）和熊本研究中，强化血糖控制可预防显性蛋白尿的进展。刘易斯研究证明了血管紧张素转换酶抑制剂（ACE抑制剂）对1型糖尿病肾病的肾脏保护作用，而雷米普利对糖尿病肾病的研究（RENAAL）和伊贝沙坦糖尿病肾病试验（IDNT）记录了2型糖尿病中血管紧张素II 1型受体阻滞剂的肾脏保护作用。此外，近期的斯滕诺2号多因素干预试验推测了降低血脂在预防糖尿病肾病方面的潜在疗效。因此，同时调整高血糖、高血压和血脂异常可能会预防和缓解糖尿病肾病。
