Schernthaner Guntram, Schernthaner Gerit Holger
Department of Medicine I, Rudolfstiftung Hospital, Vienna - Austria.
J Nephrol. 2013 Nov-Dec;26(6):975-85. doi: 10.5301/jn.5000281. Epub 2013 Jun 14.
Nephropathy is a common consequence of diabetes, with a high prevalence in patients with type 1 (15%-25%) and type 2 diabetes mellitus (T2DM; 30%-40%). Nephropathy is associated with a poor prognosis and high economic burden. The risk of developing nephropathy increases with the duration of diabetes, and early diagnosis and treatment of risk factors for nephropathy (e.g., tight control of glycemia and hypertension) can reduce the development and progression of diabetic nephropathy. Advances in our understanding of the mechanisms of renal complications associated with diabetes and the etiology of nephropathy have identified additional risk factors for nephropathy, and novel therapeutic options are being explored. This review discusses the pathophysiology of diabetic nephropathy and common risk factors. Furthermore, we discuss emerging treatments for T2DM that could potentially slow or prevent the progression of diabetic nephropathy. The use of incretin-based therapies, such as the dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) analogs, is growing in patients with T2DM, due to their efficacy and tolerability profiles. As renal safety is a key factor when choosing treatment options to manage patients with T2DM, drugs that are suitable for use in patients with varying degrees of renal impairment without a requirement for dose adjustment, such as the DPP-4 inhibitor linagliptin, are of particular use. The ongoing advances in T2DM therapy may allow optimization of glycemic control in a wide range of patients, thereby helping to reduce the increasing morbidity and mortality associated with diabetic nephropathy.
肾病是糖尿病的常见并发症，在1型糖尿病患者（15%-25%）和2型糖尿病（T2DM；30%-40%）患者中患病率很高。肾病与预后不良和高经济负担相关。肾病的发生风险随糖尿病病程延长而增加，早期诊断和治疗肾病危险因素（如严格控制血糖和血压）可减少糖尿病肾病的发生和进展。我们对糖尿病相关肾脏并发症机制及肾病病因认识的进展已确定了更多肾病危险因素，并且正在探索新的治疗选择。本综述讨论了糖尿病肾病的病理生理学和常见危险因素。此外，我们还讨论了可能减缓或预防糖尿病肾病进展的T2DM新兴治疗方法。由于其疗效和耐受性，基于肠促胰素的疗法，如二肽基肽酶-4（DPP-4）抑制剂和胰高血糖素样肽-1（GLP-1）类似物，在T2DM患者中的使用正在增加。由于肾脏安全性是选择治疗T2DM患者方案时的关键因素，像DPP-4抑制剂利格列汀这类无需调整剂量即可适用于不同程度肾功能损害患者的药物特别有用。T2DM治疗的不断进展可能使广泛患者的血糖控制得以优化，从而有助于降低与糖尿病肾病相关的发病率和死亡率的上升。
