Department of Internal Medicine and Diabetes Centre, VU University Medical Centre, Amsterdam, Netherlands.
Department of Internal Medicine and Diabetes Centre, VU University Medical Centre, Amsterdam, Netherlands.
Lancet Diabetes Endocrinol. 2015 May;3(5):367-81. doi: 10.1016/S2213-8587(15)00030-3.
In parallel with the type 2 diabetes pandemic, diabetic kidney disease has become the leading cause of end-stage renal disease worldwide, and is associated with high cardiovascular morbidity and mortality. As established in landmark randomised trials and recommended in clinical guidelines, prevention and treatment of diabetic kidney disease focuses on control of the two main renal risk factors, hyperglycaemia and systemic hypertension. Treatment of systemic hypertension with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers is advocated because these drugs seem to exert specific renoprotective effects beyond blood pressure lowering. Emerging evidence shows that obesity, glomerular hyperfiltration, albuminuria, and dyslipidaemia might also adversely affect the kidney in diabetes. Control of these risk factors could have additional benefits on renal outcome in patients with type 2 diabetes. However, despite multifactorial treatment approaches, residual risk for the development and progression of diabetic kidney disease in patients with type 2 diabetes remains, and novel strategies or therapies to treat the disease are urgently needed. Several drugs used in the treatment of type 2 diabetes are associated with pleiotropic effects that could favourably or unfavourably change patients' renal risk profile. We review the risk factors and treatment of diabetic kidney disease, and describe the pleiotropic effects of widely used drugs in type 2 diabetes management on renal outcomes, with special emphasis on antihyperglycaemic drugs.
随着 2 型糖尿病的流行，糖尿病肾病已成为全球终末期肾病的主要病因，并与较高的心血管发病率和死亡率相关。正如标志性的随机临床试验所确立的，并在临床指南中推荐的，糖尿病肾病的预防和治疗侧重于控制两个主要的肾脏危险因素，即高血糖和全身性高血压。建议使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗全身性高血压，因为这些药物似乎除了降压之外还具有特定的肾脏保护作用。新出现的证据表明，肥胖、肾小球高滤过、蛋白尿和血脂异常也可能对糖尿病患者的肾脏产生不利影响。控制这些危险因素可能对 2 型糖尿病患者的肾脏结局有额外的益处。然而，尽管采取了多因素治疗方法，2 型糖尿病患者发生和进展糖尿病肾病的残余风险仍然存在，因此迫切需要新的策略或治疗方法来治疗这种疾病。几种用于治疗 2 型糖尿病的药物与多效性作用相关，这些作用可能有利或不利地改变患者的肾脏风险状况。我们回顾了糖尿病肾病的危险因素和治疗方法，并描述了 2 型糖尿病管理中广泛使用的药物对肾脏结局的多效性作用，特别强调了降糖药物。
