Bennett P H
Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Arizona 85014.
Am J Kidney Dis. 1989 Jan;13(1):29-34. doi: 10.1016/s0272-6386(89)80111-8.
Abnormal albumin excretion in the range not previously detectable by routine clinical methods can now be readily quantified, and has been shown to predict the development of clinically significant nephropathy in insulin-dependent diabetes mellitus (IDDM) and to predict excess mortality in non-insulin-dependent diabetes mellitus (NIDDM). Albuminuria of this degree has been inappropriately called "microalbuminuria," a misleading term which should be abandoned. In IDDM, persistent minimal elevation of albumin excretion predicts the development of more severe proteinuria and clinical diabetic nephropathy, which frequently progresses to renal failure. In NIDDM, the predictive value for renal failure remains to be established, but excess mortality occurs in those with abnormal albumin excretion, suggesting that it is an indicator of generalized vascular disease. However, the normal range of albumin excretion in older subjects is not well established. The relationship of glomerular injury to mildly elevated albumin excretion is uncertain. Several means of reducing the excretion rate have been described, but whether these can halt or prevent progression of glomerular injury is unknown. Thus, at the present time detection of mildly elevated albumin excretion and intervention to reduce the incidence of diabetic nephropathy or other diabetes-related complications fail to meet generally accepted criteria for prescriptive screening. However, such measurements of albumin excretion provide an important tool for research into the natural history and pathogenesis of diabetic nephropathy.
以往常规临床方法无法检测到的异常白蛋白排泄量，现在可以很容易地进行量化，并且已被证明可预测胰岛素依赖型糖尿病（IDDM）中具有临床意义的肾病的发展，并可预测非胰岛素依赖型糖尿病（NIDDM）的额外死亡率。这种程度的白蛋白尿被不恰当地称为“微量白蛋白尿”，这是一个应摒弃的误导性术语。在IDDM中，白蛋白排泄持续轻微升高预示着更严重蛋白尿和临床糖尿病肾病的发展，而后者常进展为肾衰竭。在NIDDM中，其对肾衰竭的预测价值尚待确定，但白蛋白排泄异常者会出现额外死亡率，这表明它是全身性血管疾病的一个指标。然而，老年受试者白蛋白排泄的正常范围尚未明确。肾小球损伤与白蛋白排泄轻度升高之间的关系尚不确定。已经描述了几种降低排泄率的方法，但这些方法能否阻止或预防肾小球损伤的进展尚不清楚。因此，目前检测白蛋白排泄轻度升高以及采取干预措施以降低糖尿病肾病或其他糖尿病相关并发症的发生率，未能达到规定筛查的普遍接受标准。然而，这种白蛋白排泄量的测量为研究糖尿病肾病的自然史和发病机制提供了一个重要工具。
