Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, 06030, USA.
State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney, Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
FASEB J. 2023 Apr;37(4):e22884. doi: 10.1096/fj.202201340RR.
Acute kidney injury (AKI) and diabetes mellitus (DM) are public health problems that cause a high socioeconomic burden worldwide. In recent years, the landscape of AKI etiology has shifted: Emerging evidence has demonstrated that DM is an independent risk factor for the onset of AKI, while an alternative perspective considers AKI as a bona fide complication of DM. Therefore, it is necessary to systematically characterize the features of AKI in DM. In this review, we summarized the epidemiology of AKI in DM. While focusing on circulation- and tissue-specific microenvironment changes after DM, we described the active cellular and molecular mechanisms of increased kidney susceptibility to AKI under DM stress. We also reviewed the current diagnostic and therapeutic strategies for AKI in DM recommended in the clinic. Updated recognition of the epidemiology, pathophysiology, diagnosis, and medications of AKI in DM is believed to reveal a path to mitigate the frequency of AKI and DM comorbidity that will ultimately improve the quality of life in DM patients.
急性肾损伤 (AKI) 和糖尿病 (DM) 是全球性的公共卫生问题,给社会经济带来了沉重负担。近年来,AKI 的病因学发生了变化:新出现的证据表明 DM 是 AKI 发病的独立危险因素,而另一种观点则认为 AKI 是 DM 的一种真正并发症。因此,有必要系统地描述 DM 中 AKI 的特征。在这篇综述中,我们总结了 DM 中 AKI 的流行病学。在关注 DM 后循环和组织特异性微环境变化的同时,我们描述了在 DM 应激下增加肾脏对 AKI 易感性的活跃细胞和分子机制。我们还回顾了目前在临床上推荐的 DM 中 AKI 的诊断和治疗策略。对 DM 中 AKI 的流行病学、病理生理学、诊断和药物治疗的最新认识,有望为减轻 AKI 和 DM 合并症的发生频率开辟一条道路,从而最终提高 DM 患者的生活质量。