Tanios Bassem Y, Ziyadeh Fuad N
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
Nephron Extra. 2012 Oct 30;2(1):278-82. doi: 10.1159/000343312. Print 2012 Jan.
Diabetic nephropathy is a leading cause of end-stage renal disease worldwide. The mainstay of treatment has been glycemic control and blood pressure lowering using agents blocking the renin-angiotensin system. Clinical trials are currently under way using novel agents for the treatment of patients with diabetic nephropathy. Promising agents emerging from some of the completed trials include pirfenidone and bardoxolone methyl, which have been shown in two recent randomized controlled trials in patients with diabetic nephropathy to result in an improved estimated glomerular filtration rate compared to placebo. Also, paricalcitol has been shown to decrease the urinary albumin-to-creatinine ratio, whereas sulodexide failed to do so in a large randomized double-blind placebo-controlled trial. Of note, pyridoxamine has also shown promise in the treatment of diabetic nephropathy if started early in the disease course. These preliminary trials have shown significant promise for managing patients with diabetic nephropathy, sparking active research in this field and providing the rationale for further clinical testing in long-term, hard-outcomes trials.
糖尿病肾病是全球终末期肾病的主要病因。治疗的主要方法一直是通过使用阻断肾素 - 血管紧张素系统的药物来控制血糖和降低血压。目前正在进行使用新型药物治疗糖尿病肾病患者的临床试验。一些已完成试验中出现的有前景的药物包括吡非尼酮和巴多昔芬甲基，在最近两项针对糖尿病肾病患者的随机对照试验中显示，与安慰剂相比，它们能使估计肾小球滤过率得到改善。此外，帕立骨化醇已被证明可降低尿白蛋白与肌酐比值，而舒洛地昔在一项大型随机双盲安慰剂对照试验中未能做到这一点。值得注意的是，如果在疾病进程早期开始使用，吡哆胺在糖尿病肾病治疗中也显示出前景。这些初步试验对糖尿病肾病患者的管理显示出显著前景，激发了该领域的积极研究，并为长期、硬终点试验的进一步临床测试提供了理论依据。
