Czekalski S
Department of Nephrology, Transplantology and Internal Diseases, Poznań University of Medical Sciences, Poland.
Rocz Akad Med Bialymst. 2005;50:122-5.
Diabetic nephropathy is diagnosed either when persistent increase of urinary albumin excretion rate (UAER) above 30 mg/24h in a patient with diabetes was discovered (early or incipient nephropathy) or when UAER values are persistently elevated above 300 mg/24h (overt or clinical nephropathy). In both situations the additional criteria of presence of diabetic retinopathy and the absence of the evidence of other kidney or renal tract disease should be fulfilled. It was found that the excess of cardiovascular events and mortality occurs already in diabetic patients with persistent microalbuminuria, but is particularly evident in macroalbuminuric diabetic patients and results not only from end-stage renal failure (ESRF) but rather from cardiovascular disease (CVD), the latter mainly in type 2 diabetic patients. Several traditional risk factor for atherosclerosis has been identified in diabetic patients with micro- or macroalbuminuria including elevated blood pressure levels, dyslipidemia and procoagulatory state associated with endothelial dysfunction. Microalbuminuria is currently regarded as a marker of generalized endothelial damage, it reflects transvascular albumin leakage, now recognized as an early event in atherogenesis. Recently the association of microalbuminuria with the marker of chronic inflammation (C-reactive protein) and with increased production of vascular endothelial growth factor (VEGE) was described. Thus, multiple mechanisms are involved in the development and progression of cardiovascular complications both in micro- and macroalbuminuric diabetic patients and all these mechanisms should be regarded as the target for therapeutic intervention.
在糖尿病患者中，当发现尿白蛋白排泄率（UAER）持续高于30mg/24小时时（早期或初期肾病），或当UAER值持续高于300mg/24小时时（显性或临床肾病）。在这两种情况下，都应满足存在糖尿病视网膜病变以及无其他肾脏或尿路疾病证据的附加标准。研究发现，心血管事件和死亡率的增加在持续性微量白蛋白尿的糖尿病患者中就已出现，但在大量白蛋白尿的糖尿病患者中尤为明显，其原因不仅在于终末期肾衰竭（ESRF），更在于心血管疾病（CVD），后者主要见于2型糖尿病患者。在伴有微量或大量白蛋白尿的糖尿病患者中，已确定了几种动脉粥样硬化的传统危险因素，包括血压升高、血脂异常以及与内皮功能障碍相关的促凝状态。目前，微量白蛋白尿被视为全身性内皮损伤的标志物，它反映了跨血管白蛋白渗漏，而这现在被认为是动脉粥样硬化形成的早期事件。最近，微量白蛋白尿与慢性炎症标志物（C反应蛋白）以及血管内皮生长因子（VEGF）产生增加之间的关联也有报道。因此，微量和大量白蛋白尿的糖尿病患者发生心血管并发症的发展和进展涉及多种机制，所有这些机制都应被视为治疗干预的靶点。
