Futrakul Narisa, Futrakul Prasit
a Department of Physiology, Faculty of Medicine , King Chulalongkorn Memorial Hospital, Chulalongkorn University , Bangkok , Thailand.
b Academy of Science , The Royal Institute of Thailand and Bhumirajanagarindra Kidney Institute , Bangkok , Thailand.
Ren Fail. 2017 Nov;39(1):505-511. doi: 10.1080/0886022X.2017.1323647.
Recognition of early stage of diabetic kidney disease, under common practice using biomarkers, namely microalbuminuria, serum creatinine level above 1 mg/dL and accepted definition of diabetic kidney disease associated with creatinine clearance value below 60 mL/min/1.73 m, is unlikely. This would lead to delay treatment associated with therapeutic resistance to vasodilator due to a defective vascular homoeostasis. Other alternative biomarkers related to the state of microalbuminuria is not sensitive to screen for early diabetic kidney disease (stages I, II). In this regard, a better diagnostic markers to serve for this purpose are creatinine clearance, fractional excretion of magnesium (FE Mg), cystatin C. Recently, renal microvascular disease and renal ischemia have been demonstrated to correlate indirectly with the development of diabetic kidney disease and its function. Among these are angiogenic and anti-angiogenic factors, namely VEGF, VEGF receptors, angiopoietins and endostatin. With respect to therapeutic prevention, implementation of treatment at early stage of diabetic and nondiabetic kidney disease is able to restore renal perfusion and function.
在常规实践中，使用生物标志物（即微量白蛋白尿、血清肌酐水平高于1mg/dL以及与肌酐清除率低于60mL/min/1.73m²相关的糖尿病肾病公认定义）来识别糖尿病肾病的早期阶段是不太可能的。这将导致因血管稳态缺陷而导致与血管扩张剂治疗抵抗相关的治疗延迟。与微量白蛋白尿状态相关的其他替代生物标志物对早期糖尿病肾病（I、II期）的筛查不敏感。在这方面，用于此目的的更好诊断标志物是肌酐清除率、镁分数排泄（FE Mg）、胱抑素C。最近，已证明肾微血管疾病和肾缺血与糖尿病肾病的发展及其功能间接相关。其中包括血管生成和抗血管生成因子，即血管内皮生长因子（VEGF）、VEGF受体、血管生成素和内皮抑素。关于治疗性预防，在糖尿病和非糖尿病肾病的早期实施治疗能够恢复肾灌注和功能。
