Department of Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2018 Aug;117(8):662-675. doi: 10.1016/j.jfma.2018.02.007. Epub 2018 Mar 2.
Diabetic kidney disease (DKD) is a major cause of morbidity and mortality in patients with diabetes mellitus and the leading cause of end-stage renal disease in the world. The most characteristic marker of DKD is albuminuria, which is associated with renal disease progression and cardiovascular events. Renal hemodynamics changes, oxidative stress, inflammation, hypoxia and overactive renin-angiotensin-aldosterone system (RAAS) are involved in the pathogenesis of DKD, and renal fibrosis plays the key role. Intensified multifactorial interventions, including RAAS blockades, blood pressure and glucose control, and quitting smoking, help to prevent DKD development and progression. In recent years, novel agents are applied for preventing DKD development and progression, including new types of glucose-lowering agents, pentoxifylline, vitamin D analog paricalcitol, pyridoxamine, ruboxistaurin, soludexide, Janus kinase inhibitors and nonsteroidal minerocorticoid receptor antagonists. In this review, recent large studies about DKD are also summarized.
糖尿病肾病（DKD）是糖尿病患者发病率和死亡率的主要原因，也是世界范围内终末期肾病的主要病因。DKD 的最典型标志物是白蛋白尿，与肾脏疾病进展和心血管事件相关。肾脏血流动力学改变、氧化应激、炎症、缺氧和肾素-血管紧张素-醛固酮系统（RAAS）过度激活参与了 DKD 的发病机制，而肾脏纤维化起关键作用。强化的多因素干预，包括 RAAS 阻断、血压和血糖控制以及戒烟，有助于预防 DKD 的发生和进展。近年来，新型药物被应用于预防 DKD 的发生和进展，包括新型降糖药物、己酮可可碱、维生素 D 类似物帕立骨化醇、吡哆胺、罗苏伐他汀、舒洛地昔、Janus 激酶抑制剂和非甾体类盐皮质激素受体拮抗剂。在这篇综述中，还总结了 DKD 的一些大型研究。
