Mogensen C E
Medical Department M, Second University Clinic of Internal Medicine, Kommunehospitalet, Arhus, Denmark.
Diabetes. 1990 Jul;39(7):761-7. doi: 10.2337/diab.39.7.761.
This perspective deals with prediction of overt diabetic nephropathy in patients with insulin-dependent diabetes mellitus (IDDM). The role of elevated urinary albumin excretion rate (microalbuminuria) in predicting diabetic nephropathy has been emphasized by new follow-up studies. Development of severe kidney impairment was seen in a large percentage of patients with microalbuminuria, but with more intensive care for diabetic patients, this percentage may be falling. Herein, I analyzed alternatives to microalbuminuria in predicting kidney disease in diabetes. 1) Parental predisposition to hypertension is not seen in all studies and therefore may not be a decisive factor, and it cannot be used in prediction of nephropathy. 2) Prediabetic blood pressure may predict nephropathy in certain non-insulin-dependent diabetic patients, but elevated blood pressure seems to develop after early microalbuminuria and is likely to be an aggravating factor in established microalbuminuria in IDDM patients. 3) At the clinical diagnosis of IDDM, diabetic nephropathy cannot be predicted. 4) Glycemic control is poor in normoalbuminuric patients with later development of microalbuminuria, and multiple glycosylated hemoglobin measurements are therefore important. 5) In diabetes, glomerular hyperfiltration is associated with late nephropathy, but it alone cannot be the decisive factor, because hyperfiltration in nondiabetic individuals does not produce kidney disease, according to new long-term follow-up studies. 6) Studies of glomerular structure and ultrastructure have not yet documented predictive values for overt nephropathy, but further studies are in progress. 7) Isolated blood pressure elevation without microabuminuria (probably representing essential hypertension in diabetes) has not been predictive. 8) It is clear that elevation of serum creatinine is a very late and insensitive parameter, occurring only with pronounced proteinuria.(ABSTRACT TRUNCATED AT 250 WORDS)
这篇综述探讨了胰岛素依赖型糖尿病（IDDM）患者显性糖尿病肾病的预测问题。新的随访研究强调了尿白蛋白排泄率升高（微量白蛋白尿）在预测糖尿病肾病中的作用。大量微量白蛋白尿患者出现了严重的肾功能损害，但随着对糖尿病患者护理的加强，这一比例可能正在下降。在此，我分析了在糖尿病肾病预测中替代微量白蛋白尿的方法。1）并非所有研究都发现父母有高血压易感性，因此它可能不是一个决定性因素，不能用于肾病预测。2）糖尿病前期血压可能在某些非胰岛素依赖型糖尿病患者中预测肾病，但血压升高似乎在早期微量白蛋白尿之后出现，并且可能是IDDM患者已确诊微量白蛋白尿的一个加重因素。3）在IDDM临床诊断时，无法预测糖尿病肾病。4）正常白蛋白尿但后来出现微量白蛋白尿的患者血糖控制较差，因此多次糖化血红蛋白测量很重要。5）在糖尿病中，肾小球高滤过与晚期肾病相关，但仅凭它不能成为决定性因素，因为根据新的长期随访研究，非糖尿病个体的高滤过不会导致肾病。6）肾小球结构和超微结构研究尚未证明对显性肾病有预测价值，但进一步的研究正在进行中。7）无微量白蛋白尿的单纯血压升高（可能代表糖尿病中的原发性高血压）没有预测性。8）显然，血清肌酐升高是一个非常晚期且不敏感的指标，仅在明显蛋白尿时出现。（摘要截选至250字）
