Kitai Yuichiro, Doi Yohei, Osaki Keisuke, Sugioka Sayaka, Koshikawa Masao, Sugawara Akira
Department of Nephrology, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555, Japan.
Clin Exp Nephrol. 2015 Dec;19(6):1037-43. doi: 10.1007/s10157-015-1094-2. Epub 2015 Feb 15.
Proteinuria is an established risk factor for progression of renal disease, including diabetic nephropathy. The predictive power of proteinuria, especially nephrotic range proteinuria, for progressive renal deterioration has been well demonstrated in diabetic patients with normal to relatively preserved renal function. However, little is known about the relationship between severity of proteinuria and renal outcome in pre-dialysis diabetic patients with severely impaired renal function.
125 incident dialysis patients with type 2 diabetes were identified. This study was aimed at retrospectively evaluating the impact of nephrotic range proteinuria (urinary protein-creatinine ratio above 3.5 g/gCr) on renal function decline during the 3 months just prior to dialysis initiation.
In total, 103 patients (82.4 %) had nephrotic range proteinuria. The median rate of decline in estimated glomerular filtration rate (eGFR) in this study population was 0.98 (interquartile range 0.51-1.46) ml/min/1.73 m(2) per month. Compared to patients without nephrotic range proteinuria, patients with nephrotic range proteinuria showed significantly faster renal function decline (0.46 [0.24-1.25] versus 1.07 [0.64-1.54] ml/min/1.73 m(2) per month; p = 0.007). After adjusting for gender, age, systolic blood pressure, serum albumin, calcium-phosphorus product, hemoglobin A1c, and use of an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker, patients with nephrotic range proteinuria showed a 3.89-fold (95 % CI 1.08-14.5) increased risk for rapid renal function decline defined as a decline in eGFR ≥0.5 ml/min/1.73 m(2) per month.
Nephrotic range proteinuria is the predominant renal risk factor in type 2 diabetic patients with severely impaired renal function receiving pre-dialysis care.
蛋白尿是肾病进展的既定危险因素，包括糖尿病肾病。在肾功能正常至相对保留的糖尿病患者中，蛋白尿尤其是肾病范围蛋白尿对肾脏进行性恶化的预测能力已得到充分证实。然而，对于肾功能严重受损的透析前糖尿病患者，蛋白尿严重程度与肾脏结局之间的关系知之甚少。
确定了125例2型糖尿病初发透析患者。本研究旨在回顾性评估肾病范围蛋白尿（尿蛋白肌酐比高于3.5 g/gCr）对透析开始前3个月肾功能下降的影响。
总共103例患者（82.4%）有肾病范围蛋白尿。该研究人群中估计肾小球滤过率（eGFR）的中位数下降率为每月0.98（四分位间距0.51 - 1.46）ml/min/1.73 m²。与无肾病范围蛋白尿的患者相比，有肾病范围蛋白尿的患者肾功能下降明显更快（分别为每月0.46 [0.24 - 1.25] 与1.07 [0.64 - 1.54] ml/min/1.73 m²；p = 0.007）。在调整性别、年龄、收缩压、血清白蛋白、钙磷乘积、糖化血红蛋白以及使用血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂后，有肾病范围蛋白尿的患者肾功能快速下降（定义为eGFR每月下降≥0.5 ml/min/1.73 m²）的风险增加3.89倍（95%可信区间1.08 - 14.5）。
肾病范围蛋白尿是接受透析前护理的肾功能严重受损的2型糖尿病患者的主要肾脏危险因素。
