Pappa M, Dounousi E, Duni A, Katopodis K
Department of Nephrology, General Hospital of Arta, Arta, Greece.
Int Urol Nephrol. 2015 Aug;47(8):1365-72. doi: 10.1007/s11255-015-1012-2. Epub 2015 May 28.
Diabetes mellitus (DM) is currently considered a modern global epidemic, and diabetic nephropathy (DN) is the most common cause of chronic kidney disease (CKD). Anemia is one of the most significant complications of CKD, and it is mainly attributed to insufficient erythropoietin (EPO) production. However, anemia develops earlier in the course of CKD among patients with DM, and the severity of anemia tends to be more marked in these patients compared to nondiabetic subjects, regardless of the stage of CKD. In this review, we focus on the "less known" complex interacting mechanisms which are involved in the pathophysiology of anemia associated with DN. Although the major cause of anemia in DN is considered to be an inappropriate response of the plasma EPO concentration to anemia, several other possible mechanisms have been suggested. Glomerular hyperfiltration, proteinuria, renal tubular dysfunction and interstitial fibrosis are among the main culprits. On the other hand, systemic effects such as chronic inflammation, autonomic neuropathy and the renin-angiotensin system are also involved. Finally, several medications are considered to aggravate anemia associated with DN. Since anemia is an important predictor of quality of life and is implicated in the increased burden of cardiovascular morbidity and mortality, further research is required to elucidate its pathogenesis in diabetic patients.
糖尿病目前被视为一种现代全球性流行病，而糖尿病肾病（DN）是慢性肾脏病（CKD）最常见的病因。贫血是CKD最严重的并发症之一，主要归因于促红细胞生成素（EPO）生成不足。然而，在患有DM的CKD患者中，贫血在CKD病程中出现得更早，并且与非糖尿病患者相比，这些患者贫血的严重程度往往更明显，无论CKD处于何种阶段。在本综述中，我们聚焦于参与DN相关性贫血病理生理学的“鲜为人知”的复杂相互作用机制。虽然DN中贫血的主要原因被认为是血浆EPO浓度对贫血的不适当反应，但也提出了其他几种可能的机制。肾小球高滤过、蛋白尿、肾小管功能障碍和间质纤维化是主要原因。另一方面，慢性炎症、自主神经病变和肾素 - 血管紧张素系统等全身效应也与之相关。最后，几种药物被认为会加重DN相关性贫血。由于贫血是生活质量的重要预测指标，并与心血管疾病发病率和死亡率增加有关，因此需要进一步研究以阐明其在糖尿病患者中的发病机制。
