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糖尿病肾病新治疗方案的叙述性综述

A Narrative Review of New Treatment Options for Diabetic Nephropathy.

作者信息

Pillai Aadhira, Fulmali Darshna

机构信息

Physiology and Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND.

Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND.

出版信息

Cureus. 2023 Jan 1;15(1):e33235. doi: 10.7759/cureus.33235. eCollection 2023 Jan.

Abstract

Diabetic nephropathy (DN) is a type of nephropathy that is caused by a diabetic condition. Diabetic nephropathy is seen in type 1 and type 2 diabetes. End-stage renal disorders are brought on by DN. Diabetic nephropathy is thought to be linked to metabolic changes in the body. Proteinuria and glomerular filtration rate are the two most crucial diagnostic and prognosis measures for diabetic kidney disease (DKD), yet both have significant disadvantages. Novel biomarkers are thus increasingly required to improve risk factors and detect disease at an early stage. Controlling blood glucose and vital sign like body temperature and blood pressure, reducing cholesterol levels, and blocking the renin-angiotensin system are the standard treatments for diabetic patients. On the other hand, if used too late within the course of the disease, these therapeutic techniques can only provide partial relief from nephropathy. The complicated pathophysiology of the diabetic kidney, which experiences a variety of severe structural, metabolic, and functional alterations, represents one of the most important obstacles to the event of effective therapeutics for DN. Despite these issues, new diabetes models have identified promising treatment targets by identifying the mechanisms that control important functions of podocytes and glomerular endothelial cells. It has been shown in the vast majority of trials that renin-angiotensin system inhibitors combined with integrative therapies work well for DN. Combining sodium-glucose cotransporter-2 inhibitors and renin-angiotensin-aldosterone system blockers is a novel way to slow down the course of DKD by lowering inflammatory and fibrotic indicators brought on by hyperglycemia, which is more effective than using either medicine alone. Aldosterone receptor inhibitors and advanced glycation end-product inhibitors are two recently produced medications that may be used successfully to treat DN.

摘要

糖尿病肾病(DN)是一种由糖尿病病情引发的肾病类型。1型和2型糖尿病中均可出现糖尿病肾病。终末期肾病是由糖尿病肾病导致的。糖尿病肾病被认为与身体的代谢变化有关。蛋白尿和肾小球滤过率是糖尿病肾病(DKD)最重要的两项诊断和预后指标,但两者都有显著缺点。因此,越来越需要新型生物标志物来改善风险因素并在疾病早期进行检测。控制血糖以及体温和血压等生命体征、降低胆固醇水平以及阻断肾素 - 血管紧张素系统是糖尿病患者的标准治疗方法。另一方面,如果在疾病过程中使用过晚,这些治疗技术只能部分缓解肾病。糖尿病肾脏复杂的病理生理学经历了各种严重的结构、代谢和功能改变,这是糖尿病肾病有效治疗方法发展的最重要障碍之一。尽管存在这些问题,新的糖尿病模型通过确定控制足细胞和肾小球内皮细胞重要功能的机制,已经确定了有前景的治疗靶点。绝大多数试验表明,肾素 - 血管紧张素系统抑制剂与综合疗法联合使用对糖尿病肾病效果良好。联合使用钠 - 葡萄糖协同转运蛋白 - 2抑制剂和肾素 - 血管紧张素 - 醛固酮系统阻滞剂是一种通过降低高血糖引发的炎症和纤维化指标来减缓糖尿病肾病病程的新方法,比单独使用任何一种药物都更有效。醛固酮受体抑制剂和晚期糖基化终产物抑制剂是最近生产的两种药物,可成功用于治疗糖尿病肾病。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0726/9889842/5ca23a7e33c3/cureus-0015-00000033235-i01.jpg

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