Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy.
Biomolecules. 2023 Apr 26;13(5):752. doi: 10.3390/biom13050752.
The classic description of diabetic kidney disease (DKD) involves progressive stages of glomerular hyperfiltration, microalbuminuria, proteinuria, and a decline in the estimated glomerular filtration rate (eGFR), leading to dialysis. In recent years, this concept has been increasingly challenged as evidence suggests that DKD presents more heterogeneously. Large studies have revealed that eGFR decline may also occur independently from the development of albuminuria. This concept led to the identification of a new DKD phenotype: non-albuminuric DKD (eGFR < 60 mL/min/1.73 m, absence of albuminuria), whose pathogenesis is still unknown. However, various hypotheses have been formulated, the most likely of which is the acute kidney injury-to-chronic kidney disease (CKD) transition, with prevalent tubular, rather than glomerular, damage (typically described in albuminuric DKD). Moreover, it is still debated which phenotype is associated with a higher cardiovascular risk, due to contrasting results available in the literature. Finally, much evidence has accumulated on the various classes of drugs with beneficial effects on DKD; however, there is a lack of studies analyzing the different effects of drugs on the various phenotypes of DKD. For this reason, there are still no specific guidelines for therapy in one phenotype rather than the other, generically referring to diabetic patients with CKD.
糖尿病肾病（DKD）的经典描述涉及肾小球高滤过、微量白蛋白尿、蛋白尿和估计肾小球滤过率（eGFR）下降的进展阶段，最终导致透析。近年来，随着越来越多的证据表明 DKD 的表现更为异质，这一概念受到了越来越多的挑战。大型研究表明，eGFR 下降也可能独立于白蛋白尿的发展而发生。这一概念导致了一种新的 DKD 表型的出现：非白蛋白尿型 DKD（eGFR < 60 mL/min/1.73 m，无白蛋白尿），其发病机制尚不清楚。然而，已经提出了各种假说，最有可能的是急性肾损伤到慢性肾脏病（CKD）的转变，伴有普遍的肾小管而不是肾小球损伤（通常在白蛋白尿型 DKD 中描述）。此外，由于文献中存在相互矛盾的结果，哪种表型与更高的心血管风险相关仍存在争议。最后，大量证据表明各种类别的药物对 DKD 有有益的影响；然而，缺乏分析药物对 DKD 不同表型的不同影响的研究。出于这个原因，对于一种表型而非另一种表型的治疗方法，仍然没有具体的指南，而是笼统地针对患有 CKD 的糖尿病患者。
