Kitada Munehiro, Kanasaki Keizo, Koya Daisuke
Munehiro Kitada, Keizo Kanasaki, Daisuke Koya, Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa 920-0293, Japan.
World J Diabetes. 2014 Jun 15;5(3):342-56. doi: 10.4239/wjd.v5.i3.342.
Diabetic kidney disease (DKD) is the most common cause of chronic kidney disease, leading to end-stage renal disease and cardiovascular disease. The overall number of patients with DKD will continue to increase in parallel with the increasing global pandemic of type 2 diabetes. Based on landmark clinical trials, DKD has become preventable by controlling conventional factors, including hyperglycemia and hypertension, with multifactorial therapy; however, the remaining risk of DKD progression is still high. In this review, we show the importance of targeting remission/regression of microalbuminuria in type 2 diabetic patients, which may protect against the progression of DKD and cardiovascular events. To achieve remission/regression of microalbuminuria, several steps are important, including the early detection of microalbuminuria with continuous screening, targeting HbA1c < 7.0% for glucose control, the use of renin angiotensin system inhibitors to control blood pressure, the use of statins or fibrates to control dyslipidemia, and multifactorial treatment. Reducing microalbuminuria is therefore an important therapeutic goal, and the absence of microalbuminuria could be a pivotal biomarker of therapeutic success in diabetic patients. Other therapies, including vitamin D receptor activation, uric acid-lowering drugs, and incretin-related drugs, may also be promising for the prevention of DKD progression.
糖尿病肾病（DKD）是慢性肾病最常见的病因，可导致终末期肾病和心血管疾病。随着全球2型糖尿病大流行的加剧，DKD患者的总数将持续增加。基于具有里程碑意义的临床试验，通过多因素治疗控制包括高血糖和高血压在内的传统因素，DKD已变得可预防；然而，DKD进展的剩余风险仍然很高。在本综述中，我们展示了针对2型糖尿病患者微量白蛋白尿缓解/消退的重要性，这可能预防DKD进展和心血管事件。为实现微量白蛋白尿的缓解/消退，几个步骤很重要，包括通过持续筛查早期检测微量白蛋白尿、将糖化血红蛋白（HbA1c）控制目标设定为<7.0%以控制血糖、使用肾素-血管紧张素系统抑制剂控制血压、使用他汀类药物或贝特类药物控制血脂异常以及多因素治疗。因此，减少微量白蛋白尿是一个重要的治疗目标，且无微量白蛋白尿可能是糖尿病患者治疗成功的关键生物标志物。其他疗法，包括维生素D受体激活、降尿酸药物和肠促胰岛素相关药物，对于预防DKD进展也可能很有前景。
