Schrier R W, Holzgreve H
Department of Medicine, University of Colorado School of Medicine.
Klin Wochenschr. 1988 Apr 15;66(8):325-31. doi: 10.1007/BF01735788.
The pathogenesis of the diabetic glomerular lesion is unknown. However, cumulative indirect evidence favors hemodynamic factors associated with the abnormal endocrine environment as the cause of diabetic angiopathy. Experimental evidence suggests that the increased hydrostatic pressures in capillary beds, a hallmark of the early stages of insulin-dependent diabetes, are associated with macromolecular leakage leading to the typical thickening of glomerular capillary basement membrane and increased glomerular mesangial matrix even prior to the occurrence of systemic hypertension. Patients with renal or carotid artery stenosis seem to be protected against diabetic nephropathy and retinopathy on the stenosed side. The first signal of diabetic nephropathy even before deterioration of the renal function is microalbuminuria detected by sensitive methods such as radioimmunoassay. Not only in hypertensive, but even in normotensive diabetic patients with microalbuminuria antihypertensive therapy has been shown to reduce albumin excretion rate and to slow the progression of diabetic nephropathy. Once overt diabetic nephropathy has been established, hypertension is a constant accompaniment of the disease. Thus, hypertension may be a cause as well as a result of diabetic nephropathy. Tight control of blood sugar in close association with antihypertensive treatment reducing blood pressure to a lower normal limit, possibly with agents that specifically decrease glomerular capillary hydraulic pressure are the corner stone in protection against progression of the diabetic angiopathy.
糖尿病肾小球病变的发病机制尚不清楚。然而，累积的间接证据表明，与异常内分泌环境相关的血流动力学因素是糖尿病血管病变的病因。实验证据表明，毛细血管床静水压升高是胰岛素依赖型糖尿病早期阶段的一个特征，在系统性高血压出现之前，就与大分子渗漏有关，进而导致肾小球毛细血管基底膜典型增厚和肾小球系膜基质增加。肾动脉或颈动脉狭窄的患者，其狭窄侧似乎对糖尿病肾病和视网膜病变具有保护作用。在肾功能恶化之前，糖尿病肾病的首个信号是通过放射免疫分析等敏感方法检测到的微量白蛋白尿。不仅在高血压糖尿病患者中，而且在有微量白蛋白尿的血压正常的糖尿病患者中，抗高血压治疗均已显示可降低白蛋白排泄率，并减缓糖尿病肾病的进展。一旦确诊为显性糖尿病肾病，高血压就始终伴随着该疾病。因此，高血压可能是糖尿病肾病的病因，也可能是其结果。将血糖严格控制，同时进行抗高血压治疗，将血压降至更低的正常范围，可能需要使用能特异性降低肾小球毛细血管液压的药物，这是预防糖尿病血管病变进展的基石。
