University of Chicago Pritzker School of Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA.
Mayo Clin Proc. 2011 May;86(5):444-56. doi: 10.4065/mcp.2010.0713.
Nephropathy is a common microvascular complication among patients with type 2 diabetes mellitus and a major cause of kidney failure. It is characterized by albuminuria (≥ 300 mg/d) and a reduced glomerular filtration rate and is often present at the time of diabetes diagnosis after the kidney has been exposed to chronic hyperglycemia during the prediabetic phase. A low glomerular filtration rate (<60 mL/min/1.73 m(2)) is also an independent risk factor for cardiovascular events and death. Detection of diabetic nephropathy during its initial stages provides the opportunity for early therapeutic interventions to prevent or delay the onset of complications and improve outcomes. An intensive and multifactorial management approach is needed that targets all risk determinants simultaneously. The strategy should comprise lifestyle modifications (smoking cessation, weight loss, increased physical activity, and dietary changes) coupled with therapeutic achievement of blood glucose, blood pressure, and lipid goals that are evidence-based. Prescribing decisions should take into account demographic factors, level of kidney impairment, adverse effects, risk of hypoglycemia, tolerability, and effects on other risk factors and comorbidities. Regular and comprehensive follow-up assessments with appropriate adjustment of the therapeutic regimen to maintain risk factor control is a vital component of care, including referral to specialists, when required.
肾病是 2 型糖尿病患者常见的微血管并发症，也是导致肾衰竭的主要原因。其特征是出现白蛋白尿（≥ 300mg/d）和肾小球滤过率降低，通常在糖尿病诊断时出现，此时肾脏在糖尿病前期已长期暴露于慢性高血糖环境中。肾小球滤过率低（<60mL/min/1.73m(2)）也是心血管事件和死亡的独立危险因素。在其早期阶段发现糖尿病肾病，为早期治疗干预提供了机会，可预防或延缓并发症的发生并改善预后。需要采用强化和多因素管理方法，同时针对所有风险决定因素进行治疗。该策略应包括生活方式的改变（戒烟、减肥、增加身体活动和饮食改变），并结合基于证据的血糖、血压和血脂治疗目标的实现。在制定处方决策时，应考虑到人口统计学因素、肾功能损害程度、不良反应、低血糖风险、耐受性以及对其他危险因素和合并症的影响。定期进行全面的随访评估，并适当调整治疗方案以维持危险因素控制，这是治疗的重要组成部分，包括在必要时转介给专科医生。
