Faculty of Clinical Medical Sciences, Institute of Cellular Medicine, Newcastle University, Floor 4, Leech Building, Framlington Place, Newcastle upon Tyne NE2 4HH, UK.
Diabetologia. 2012 Sep;55(9):2301-6. doi: 10.1007/s00125-012-2606-1. Epub 2012 Jun 14.
This edition of Then and Now discusses three papers published in Diabetologia in the 1980s relating to diabetic nephropathy. Two epidemiological papers by Andersen et al (1983; 25:496-501) and Borch-Johnsen et al (1985; 28:590-596) described in graphic detail the ravages of diabetic nephropathy in type 1 diabetes. After 40 years of diabetes, 41% of their cohort had developed persistent proteinuria. The median time from first appearance of proteinuria to death was 7-8 years, the majority dying of uraemia or cardiovascular disease. The third paper, by Mathiesen et al (1984; 26:406-410), identified individuals with microalbuminuria, a much earlier stage of diabetic nephropathy, and analysed the risk of progression to persistent proteinuria at various levels of urine albumin excretion. Since the description of microalbuminuria, clinicians have hoped that earlier identification of individuals at high risk of end-stage kidney disease, coupled with aggressive use of reno-protective therapies, would prevent, or at the very least significantly delay, the development of end-stage renal disease. Recent data suggest that the outlook has indeed improved since the 1980s, at least in some populations. However, we may be delaying rather than preventing the development of microalbuminuria, proteinuria and kidney failure. Whilst a delay of 10 or more years in the appearance of end-stage renal disease is very welcome, further work is needed to understand why rates of chronic kidney disease vary substantially between cohorts and to develop novel therapies.
本期“过去与现在”讨论了 1980 年代发表在《糖尿病学》上的三篇与糖尿病肾病相关的论文。Andersen 等人（1983 年；25：496-501）和 Borch-Johnsen 等人（1985 年；28：590-596）的两篇流行病学论文详细描述了 1 型糖尿病患者糖尿病肾病的严重后果。在糖尿病发病 40 年后，他们的队列中有 41%出现持续性蛋白尿。从首次出现蛋白尿到死亡的中位时间为 7-8 年，大多数患者死于尿毒症或心血管疾病。第三篇论文由 Mathiesen 等人（1984 年；26：406-410）撰写，确定了微量白蛋白尿患者（糖尿病肾病的更早阶段），并分析了不同尿白蛋白排泄水平下进展为持续性蛋白尿的风险。自微量白蛋白尿描述以来，临床医生一直希望通过更早地识别出处于终末期肾病高风险的个体，并积极使用肾保护疗法，来预防或至少显著延迟终末期肾病的发生。最近的数据表明，自 1980 年代以来，情况确实有所改善，至少在某些人群中是这样。然而，我们可能只是在延迟而不是预防微量白蛋白尿、蛋白尿和肾衰竭的发生。尽管终末期肾病出现时间延迟 10 年或更长时间是非常令人欢迎的，但仍需要进一步研究以了解为什么慢性肾病的发生率在不同队列之间存在显著差异，并开发新的治疗方法。
