Klimontov V V, Korbut A I
Research Institute of Clinical and Experimental Lymphology - Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, Russia.
Ter Arkh. 2018 Nov 22;90(10):94-98. doi: 10.26442/terarkh2018901094-98.
Urinary albumin excretion (UAE) is widely used in clinical practice as indicator of diabetic kidney disease. According to the classical concept of the natural course of diabetic nephropathy, an increase in UAE usually precedes a decline in renal function. Meanwhile, a growing body of evidences indicates a high prevalence of normoalbuminuric chronic kidney disease (NA-CKD) in diabetic subjects, especially among patients with type 2 diabetes. An increase in NA-CKD prevalence can be results of improved glucose, blood pressure, and lipid control, widespread use of renin-angiotensin system blockers, and smoking cessation. It was shown that NA-CKD is more prevalent among women and is associated with arterial hypertension and coronary artery disease. The renal structure in subjects with NA-CKD is more heterogeneous when compared to patients with increased albuminuria, wherein interstitial changes and arteriolosclerosis could be the principal morphological findings, while signs of glomerulopathy may be absent. The prognostic value of NA-CKD needs to be clarified. It was shown that NA-CKD increases the risk of myocardial infarction, stroke and cardiovascular death in patients with diabetes. The search for alternative diagnostic markers for detecting of diabetic kidney disease in the absence of albuminuria, is of practical importance. The evaluations of the markers of tubular damage and interstitial fibrosis, as well as proteomic approaches, are considered as perspective diagnostic and prognostic options in NA-CKD. The study of pathogenesis, pathology, clinical course of NA-CKD in diabetic patients, as well as the development of more specific diagnostic and treatment options is a challenge for future research.
尿白蛋白排泄率（UAE）在临床实践中被广泛用作糖尿病肾病的指标。根据糖尿病肾病自然病程的经典概念，UAE升高通常先于肾功能下降。与此同时，越来越多的证据表明，糖尿病患者中正常白蛋白尿慢性肾脏病（NA-CKD）的患病率很高，尤其是在2型糖尿病患者中。NA-CKD患病率增加可能是血糖、血压和血脂控制改善、肾素-血管紧张素系统阻滞剂广泛使用以及戒烟的结果。研究表明，NA-CKD在女性中更为普遍，且与动脉高血压和冠状动脉疾病有关。与白蛋白尿增加的患者相比，NA-CKD患者的肾脏结构更具异质性，其中间质变化和小动脉硬化可能是主要的形态学表现，而可能没有肾小球病变的迹象。NA-CKD的预后价值需要阐明。研究表明，NA-CKD会增加糖尿病患者发生心肌梗死、中风和心血管死亡的风险。寻找在无白蛋白尿情况下检测糖尿病肾病的替代诊断标志物具有实际意义。评估肾小管损伤和间质纤维化标志物以及蛋白质组学方法，被认为是NA-CKD中有前景的诊断和预后选择。研究糖尿病患者NA-CKD的发病机制、病理学、临床病程以及开发更具特异性的诊断和治疗方法是未来研究的一项挑战。
