Division of Nephrology, Medizinische Klinik and Poliklinik IV, Klinikum der LMU München - Innenstadt, München, Germany.
III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Nat Rev Nephrol. 2018 Jun;14(6):361-377. doi: 10.1038/s41581-018-0001-y.
The increasing global prevalence of type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) has prompted research efforts to tackle the growing epidemic of diabetic kidney disease (DKD; also known as diabetic nephropathy). The limited success of much of this research might in part be due to the fact that not all patients diagnosed with DKD have renal dysfunction as a consequence of their diabetes mellitus. Patients who present with CKD and diabetes mellitus (type 1 or type 2) can have true DKD (wherein CKD is a direct consequence of their diabetes status), nondiabetic kidney disease (NDKD) coincident with diabetes mellitus, or a combination of both DKD and NDKD. Preclinical studies using models that more accurately mimic these three entities might improve the ability of animal models to predict clinical trial outcomes. Moreover, improved insights into the pathomechanisms that are shared by these entities - including sodium-glucose cotransporter 2 (SGLT2) and renin-angiotensin system-driven glomerular hyperfiltration and tubular hyper-reabsorption - as well as those that are unique to individual entities might lead to the identification of new treatment targets. Acknowledging that the clinical entity of CKD plus diabetes mellitus encompasses NDKD as well as DKD could help solve some of the urgent unmet medical needs of patients affected by these conditions.
2 型糖尿病（T2DM）和慢性肾脏病（CKD）在全球的患病率不断上升，促使人们努力研究如何应对糖尿病肾病（DKD；也称为糖尿病性肾病）这一日益严重的流行疾病。这项研究的大部分成果都很有限，部分原因可能是并非所有被诊断患有 DKD 的患者的肾功能都因糖尿病而受损。患有 CKD 和糖尿病（1 型或 2 型）的患者可能患有真正的 DKD（其中 CKD 是其糖尿病状况的直接后果）、合并糖尿病的非糖尿病性肾脏疾病（NDKD），或 DKD 和 NDKD 两者兼有。使用更准确地模拟这三种疾病的模型进行临床前研究，可能会提高动物模型预测临床试验结果的能力。此外，深入了解这些实体共有的病理机制，包括钠-葡萄糖共转运蛋白 2（SGLT2）和肾素-血管紧张素系统驱动的肾小球高滤过和管状高重吸收，以及那些特定于单个实体的机制，可能会发现新的治疗靶点。承认 CKD 加糖尿病的临床实体包括 NDKD 以及 DKD，可以帮助解决受这些疾病影响的患者的一些迫切未满足的医疗需求。
