Department of Epidemiology and Preventive Medicine, Alfred Centre, Monash University, Melbourne, Victoria 3004, Australia.
Med Clin North Am. 2013 Jan;97(1):1-18. doi: 10.1016/j.mcna.2012.10.001.
The increasing prevalence of diabetes has led to DKD becoming the leading cause of ESRD in many regions. The economic cost of DKD will grow to prohibitive amounts unless strategies to prevent its onset or progression are urgently implemented. In type 1 and type 2 diabetes, the presence of microalbuminuria and macroalbuminuria confers increased risk of developing ESRD and of death. Comparison of recent studies with earlier historical studies shows that the incidence of ESRD and death has decreased in DKD. Increased risk of albuminuria has been identified in certain non-European ethnic groups. However, the initial concept of progression of DKD as an albuminuric phenotype involving development of microalbuminuria, macroalbuminuria, and then ESRD has had to be modified. Albumin excretion frequently regresses, and GFR can decline without abnormality in albumin excretion. There is emerging evidence that changes in renal function occurring early in the course of diabetes predict future outcomes. The major challenges are to prevent DKD onset, to detect it early, and to improve DKD outcomes globally.
糖尿病的发病率不断上升，导致 DKD 在许多地区成为 ESRD 的主要病因。除非紧急实施预防 DKD 发病或进展的策略，否则 DKD 的经济成本将增长到难以承受的程度。在 1 型和 2 型糖尿病中，微量白蛋白尿和大量白蛋白尿的存在增加了发生 ESRD 和死亡的风险。最近的研究与早期的历史研究相比表明，DKD 患者的 ESRD 和死亡发生率有所下降。某些非欧洲族裔群体的白蛋白尿风险增加。然而，DKD 进展的初始概念作为涉及微量白蛋白尿、大量白蛋白尿然后 ESRD 发展的白蛋白尿表型，已不得不进行修正。白蛋白排泄经常恢复正常，而 GFR 可以在白蛋白排泄正常的情况下下降。有新的证据表明，糖尿病病程早期肾功能的变化可以预测未来的结果。主要的挑战是预防 DKD 的发病，早期发现它，并改善全球的 DKD 结果。
