Maher J F
Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Am Fam Physician. 1992 Apr;45(4):1661-8.
Diabetic nephropathy typically presents more than a decade after diagnosis of diabetes and correlates with the duration of poorly controlled disease. Diabetic nephropathy begins as glomerular hypertension and hyperfiltration, followed by microalbuminuria and the development of hypertension, overt proteinuria, nephrotic syndrome, and a progressive decline in the glomerular filtration rate. Increasing expansion of the glomerular mesangium correlates with loss of function, resulting in uremia. This process eventually leads to the need for dialysis or renal transplantation in 30 percent of patients with insulin-dependent diabetes. By lowering intraglomerular pressure through enhanced glycemic control, inhibition of angiotensin and limitation of protein intake, severe nephropathy may be prevented, delayed or even partially reversed. Treatment must stress control of hypertension.
糖尿病肾病通常在糖尿病诊断后十多年出现，与疾病控制不佳的持续时间相关。糖尿病肾病始于肾小球高血压和高滤过，随后出现微量白蛋白尿，并发展为高血压、显性蛋白尿、肾病综合征以及肾小球滤过率的逐渐下降。肾小球系膜的不断扩张与功能丧失相关，导致尿毒症。这一过程最终使30%的胰岛素依赖型糖尿病患者需要进行透析或肾移植。通过强化血糖控制、抑制血管紧张素和限制蛋白质摄入来降低肾小球内压力，可预防、延缓甚至部分逆转严重肾病。治疗必须强调控制高血压。
