Gnudi Luigi, Goldsmith David
F1000 Med Rep. 2010 Mar 15;2:18. doi: 10.3410/M2-18.
Diabetic nephropathy (diabetic kidney disease) is defined as a rise in urinary albumin excretion rate, often associated with an increase in blood pressure, and typically with concomitant retinopathy but without evidence of other causes of renal disease. It is characterized first by albuminuria and then by a progressive decline in glomerular filtration rate, eventually resulting in end-stage renal disease (ESRD). Diabetic nephropathy occurs in approximately 30-35% of type 1 and type 2 patients and tends to cluster in families. Diabetic kidney disease is associated with a very marked increase in cardiovascular disease and, even from the earliest stages, with microalbuminuria. A diabetic milieu is required for the diabetic glomerular lesion to develop, and the renin angiotensin aldosterone system (RAAS) has been implicated in the development and progression of diabetic nephropathy. Most patients with diabetes and renal impairment die from a cardiovascular disease event before they progress to ESRD. From the studies described in this review, we think that clear evidence of RAAS inhibition in the prevention of diabetic nephropathy is lacking and more studies are warranted. Nevertheless, tight blood pressure control with inhibitor of RAAS and multifactorial intervention (glycaemic, lipid control and so on) are warranted for secondary prevention and treatment of chronic kidney disease in diabetes.
糖尿病肾病（糖尿病性肾脏疾病）定义为尿白蛋白排泄率升高，常伴有血压升高，通常伴有视网膜病变，但无其他肾脏疾病病因的证据。其首先表现为蛋白尿，随后肾小球滤过率逐渐下降，最终导致终末期肾病（ESRD）。1型和2型糖尿病患者中约30 - 35%会发生糖尿病肾病，且有家族聚集倾向。糖尿病性肾脏疾病与心血管疾病的显著增加相关，甚至从最早阶段的微量白蛋白尿起就有关联。糖尿病性肾小球病变的发生需要糖尿病环境，肾素 - 血管紧张素 - 醛固酮系统（RAAS）与糖尿病肾病的发生和进展有关。大多数糖尿病和肾功能损害患者在进展至ESRD之前死于心血管疾病事件。从本综述中描述的研究来看，我们认为缺乏RAAS抑制在预防糖尿病肾病方面的明确证据，需要更多研究。然而，使用RAAS抑制剂严格控制血压以及进行多因素干预（血糖、血脂控制等）对于糖尿病慢性肾病的二级预防和治疗是必要的。
