Trofimenko I I, Dobronravov V A, Bystrova N N, Drozdova Iu V, Galkina O V, Smirnov A V
Ter Arkh. 2008;80(6):48-52.
To evaluate prevalence of subnormal glomerular filtration rate (GFR) in diabetes mellitus (DM) patients with reference to albuminuria level.
GFR by MDRD and urine excretion of protein/albumin were estimated in 851 diabetic patients (473 with type 1 DM and 378 with type 2 DM).
Normoalbuminuria (NAU), microalbuminuria (MAU) and proteinuria were detected in 54, 16 and 30% type 1 diabetics, respectively; 77% had subnormal GFR, in NAU 8.3% had GFR decline (< 60 ml/min) corresponding to stage III-IV chronic disease of the kidneys. In MAU the latter was present in 16.4%, in proteinuria--in 62.8%. Type 2 diabetics had NAU in 33.6% cases, MAU--in 17.7%, proteinuria--in 48.7%. Subnormal GFR < 60 ml/min was found in 40% cases with NAU and MAU. Most patients with proteinuria had chronic disease of the kidneys of stage III-V In a normal creatinine concentration in blood serum subnormal GFR < 60 ml/min was observed in type 1 DM in 7.6, in type 2 DM--in 33% cases.
Prevalence of subnormal GFR in diabetic patients with NAU and MAU is rather high. This necessitates wide introduction of this index in screening, follow-up and classification of renal damage severity in DM as well as estimation of albuminuria/proteinuria.
参照蛋白尿水平评估糖尿病(DM)患者肾小球滤过率(GFR)低于正常水平的患病率。
对851例糖尿病患者(473例1型糖尿病患者和378例2型糖尿病患者)进行了MDRD法估算GFR及尿蛋白/白蛋白排泄情况的检测。
1型糖尿病患者中,分别有54%、16%和30%检测出正常白蛋白尿(NAU)、微量白蛋白尿(MAU)和蛋白尿;77%的患者GFR低于正常水平,在NAU患者中,8.3%的患者GFR下降(<60 ml/分钟),相当于肾脏慢性疾病III-IV期。在MAU患者中,这一比例为16.4%,在蛋白尿患者中为62.8%。2型糖尿病患者中,33.6%的病例为NAU,17.7%为MAU,48.7%为蛋白尿。在NAU和MAU患者中,40%的病例GFR低于60 ml/分钟。大多数蛋白尿患者患有III-V期肾脏慢性疾病。在血清肌酐浓度正常的情况下,1型糖尿病患者中7.6%、2型糖尿病患者中33%的病例观察到GFR低于60 ml/分钟。
NAU和MAU糖尿病患者中GFR低于正常水平的患病率相当高。这就需要在糖尿病肾脏损害严重程度的筛查、随访和分类以及蛋白尿/蛋白尿评估中广泛引入该指标。