Kopyt Nelson P
Temle University, Philadelphia, PA, USA.
J Am Osteopath Assoc. 2005 Apr;105(4):207-15.
Patients in whom nephropathy develops as a result of hypertension or diabetes mellitus are more likely to die of cardiovascular disease (CVD) than of kidney disease. An early sign of impending nephropathy is microalbuminuria, defined as urinary excretion of albumin at a rate of 28.8 mg/24 h to 288 mg/24 h. Microalbuminuria is a marker of endothelial dysfunction, vascular injury, and renal disease and CVD, and it is associated with increased risk for myocardial infarction. Oxidative stress and endothelial dysfunction are unifying factors mediated by the renin-angiotensin system in renal disease and CVD. Clinical trials show reduced cardiovascular risk and a reversal of microalbuminuria with the use of agents that affect the renin-angiotensin system: angiotensin-receptor blockers in patients with type 2 diabetes mellitus and nephropathy, or angiotensin-converting enzyme inhibitors in patients with type 1 diabetes mellitus.
因高血压或糖尿病而发展为肾病的患者死于心血管疾病（CVD）的可能性高于死于肾病的可能性。即将发生肾病的早期迹象是微量白蛋白尿，定义为白蛋白尿排泄率为28.8 mg/24小时至288 mg/24小时。微量白蛋白尿是内皮功能障碍、血管损伤、肾病和心血管疾病的标志物，并且与心肌梗死风险增加相关。氧化应激和内皮功能障碍是由肾素-血管紧张素系统介导的肾病和心血管疾病中的共同因素。临床试验表明，使用影响肾素-血管紧张素系统的药物可降低心血管风险并逆转微量白蛋白尿：2型糖尿病和肾病患者使用血管紧张素受体阻滞剂，1型糖尿病患者使用血管紧张素转换酶抑制剂。
