Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Diabetol Metab Syndr. 2009 Sep 21;1(1):10. doi: 10.1186/1758-5996-1-10.
Diabetic nephropathy is the leading cause of chronic renal disease and a major cause of cardiovascular mortality. Diabetic nephropathy has been categorized into stages: microalbuminuria and macroalbuminuria. The cut-off values of micro- and macroalbuminuria are arbitrary and their values have been questioned. Subjects in the upper-normal range of albuminuria seem to be at high risk of progression to micro- or macroalbuminuria and they also had a higher blood pressure than normoalbuminuric subjects in the lower normoalbuminuria range. Diabetic nephropathy screening is made by measuring albumin in spot urine. If abnormal, it should be confirmed in two out three samples collected in a three to six-months interval. Additionally, it is recommended that glomerular filtration rate be routinely estimated for appropriate screening of nephropathy, because some patients present a decreased glomerular filtration rate when urine albumin values are in the normal range. The two main risk factors for diabetic nephropathy are hyperglycemia and arterial hypertension, but the genetic susceptibility in both type 1 and type 2 diabetes is of great importance. Other risk factors are smoking, dyslipidemia, proteinuria, glomerular hyperfiltration and dietary factors. Nephropathy is pathologically characterized in individuals with type 1 diabetes by thickening of glomerular and tubular basal membranes, with progressive mesangial expansion (diffuse or nodular) leading to progressive reduction of glomerular filtration surface. Concurrent interstitial morphological alterations and hyalinization of afferent and efferent glomerular arterioles also occur. Podocytes abnormalities also appear to be involved in the glomerulosclerosis process. In patients with type 2 diabetes, renal lesions are heterogeneous and more complex than in individuals with type 1 diabetes. Treatment of diabetic nephropathy is based on a multiple risk factor approach, and the goal is retarding the development or progression of the disease and to decrease the subject's increased risk of cardiovascular disease. Achieving the best metabolic control, treating hypertension (<130/80 mmHg) and dyslipidemia (LDL cholesterol <100 mg/dl), using drugs that block the renin-angiotensin-aldosterone system, are effective strategies for preventing the development of microalbuminuria, delaying the progression to more advanced stages of nephropathy and reducing cardiovascular mortality in patients with diabetes.
糖尿病肾病是慢性肾脏病的主要病因，也是心血管疾病死亡的主要原因之一。糖尿病肾病已分为微白蛋白尿和大量白蛋白尿两个阶段。微量白蛋白尿和大量白蛋白尿的截断值是任意的，其值一直受到质疑。尿白蛋白处于正常值上限的受试者似乎有进展为微量白蛋白尿或大量白蛋白尿的高风险，并且他们的血压也高于处于正常值下限的正常白蛋白尿受试者。糖尿病肾病的筛查是通过测量尿液中的白蛋白来进行的。如果异常，应在三至六个月的时间内收集三个样本中的两个样本进行确认。此外，建议常规估计肾小球滤过率，以适当筛查肾病，因为一些患者的尿白蛋白值正常，但肾小球滤过率降低。糖尿病肾病的两个主要危险因素是高血糖和动脉高血压，但 1 型和 2 型糖尿病的遗传易感性非常重要。其他危险因素包括吸烟、血脂异常、蛋白尿、肾小球高滤过和饮食因素。1 型糖尿病患者的肾病在病理学上表现为肾小球和肾小管基底膜增厚，系膜扩张（弥漫性或结节性）导致肾小球滤过表面逐渐减少。同时也会发生间质形态改变和入球和出球小动脉的玻璃样变。足细胞异常似乎也参与了肾小球硬化过程。2 型糖尿病患者的肾脏病变比 1 型糖尿病患者更为异质和复杂。糖尿病肾病的治疗基于多因素方法，目标是延缓疾病的发展或进展，并降低患者心血管疾病的风险增加。实现最佳代谢控制、治疗高血压（<130/80mmHg）和血脂异常（LDL 胆固醇<100mg/dl）、使用阻断肾素-血管紧张素-醛固酮系统的药物，是预防微量白蛋白尿发展、延缓肾病进展和降低糖尿病患者心血管死亡率的有效策略。
