Panduru N M, Chivu Laura Ioana, Chivu R D, Bădărău Ioana Anca, Albu D F, Fica Simona, Ion Daniela Adriana
Institutul National de Diabet, Nutriţie şi Boli metabolice N. C. Paulescu Bucureşti Universitatea de Medicină şi Farmacie Craiova.
Rev Med Chir Soc Med Nat Iasi. 2009 Jan-Mar;113(1):32-41.
Contemplation of non-genetic risk factors that are influencing the onset and development of diabetic nephropathy (diabetic kidney disease--DKD) is very important. This article is integrative, assessing the existent data about several possible risk factors for DKD. Because the age of onset and postpubertal duration of diabetes seems to be strongly correlated with DKD, it is feasible for puberty to be another independent risk factor. Data analysis regarding puberty and possible explanatory mechanisms to link it with DKD, as the connection with DKD of other situations, with special hormonal status (like pregnancy), is also part of this article. Summing up the data about hormonal status, we can conclude that ANF levels are a risk factor for diabetic nephropathy because they are implicated in diminution of urinary Na elimination and hypertension and subsequent urinary albumin excretion (UAE) in case of inadequate glycaemic control. The evidences regarding GH are indicating that it is a risk factor for DKD and that he is probably implicated in glomerular hypertrophy onset at puberty. The urinary elimination levels of GH are very strong correlated with UAE being putative early marker for DKD. Also the GH deficiency seems to be a protective mechanism for DKD apparition. GH is strongly correlated with IGF-1 that has very high urinary levels in microalbuminuric patients. These levels are very well related to UAE, kidney volume--important markers for glomerular hypertrophy. The evidences accumulated until now regarding the role of masculine gender, testosterone and estrogens in DKD are inarticulate.
考虑影响糖尿病肾病（糖尿病性肾脏疾病-DKD）发病和发展的非遗传风险因素非常重要。本文是综合性的，评估了有关DKD几种可能风险因素的现有数据。由于糖尿病的发病年龄和青春期后病程似乎与DKD密切相关，青春期成为另一个独立风险因素是可行的。关于青春期以及将其与DKD联系起来的可能解释机制的数据分析，以及与其他情况（如特殊激素状态-妊娠）与DKD的联系，也是本文的一部分。总结有关激素状态的数据，我们可以得出结论，心钠素水平是糖尿病肾病的一个风险因素，因为在血糖控制不佳的情况下，它们与尿钠排泄减少、高血压以及随后的尿白蛋白排泄（UAE）有关。关于生长激素（GH）的证据表明，它是DKD的一个风险因素，并且可能与青春期肾小球肥大的发生有关。GH的尿排泄水平与UAE密切相关，UAE是DKD的假定早期标志物。此外，GH缺乏似乎是DKD发生的一种保护机制。GH与胰岛素样生长因子-1（IGF-1）密切相关，在微量白蛋白尿患者中IGF-1的尿水平非常高。这些水平与UAE、肾脏体积密切相关，而肾脏体积是肾小球肥大的重要标志物。到目前为止，关于男性性别、睾酮和雌激素在DKD中的作用所积累的证据尚不明确。
