Aubia J, Hojman L, Chine M, Lloveras J, Masramon J, Llorach I, Cuevas X, Puig J M
Clin Nephrol. 1987 Jan;27(1):15-20.
Serum creatinine levels were determined prospectively every 2 to 3 months in 40 patients with diabetic nephropathy for a global observation period of 864 months. The monthly creatinine increasing rate was significantly lower in normotensive periods, mean arterial pressure (MAP) less than 115 mmHg, when compared with hypertensive periods, MAP greater than 125 mmHg. No significant difference was shown in periods with borderline hypertension (MAP between 115-124 mmHg). The mean creatinine increases were of 0.036 mg/dl/month, 0.3 mg/dl/month and 0.046 mg/dl/month respectively. Normotension was associated with a slowing down of the rate of decline in renal function in this group of moderate kidney failure with an initial mean serum creatinine of 2.26 mg/dl. The exposure of patients to nephrotoxics (aminoglycosides, and possibly anesthesia) significantly accelerated the decline in renal function: 0.39 mg/dl/month and 0.17 mg/dl/month respectively according to the concomitance or not of toxics and hypertension. The reported protective effect of diabetes against aminoglycosides nephrotoxicity in experimental conditions was not reflected in our clinical results. On the contrary, we suggest a possible enhanced sensibility of the diabetic patient with diabetic nephropathy to aminoglycosides leading to an acceleration of the progression of renal failure.
对40例糖尿病肾病患者进行前瞻性研究，每2至3个月测定一次血清肌酐水平，总观察期为864个月。与高血压期（平均动脉压（MAP）大于125 mmHg）相比，血压正常期（MAP小于115 mmHg）的每月肌酐增长率显著更低。临界高血压期（MAP在115 - 124 mmHg之间）未显示出显著差异。肌酐平均每月增加量分别为0.036 mg/dl、0.3 mg/dl和0.046 mg/dl。在这组初始平均血清肌酐为2.26 mg/dl的中度肾衰竭患者中，血压正常与肾功能下降速率减缓相关。患者接触肾毒性物质（氨基糖苷类药物，可能还有麻醉剂）会显著加速肾功能下降：根据是否同时存在毒性物质和高血压，分别为每月0.39 mg/dl和0.17 mg/dl。实验条件下报道的糖尿病对氨基糖苷类药物肾毒性的保护作用在我们的临床结果中未得到体现。相反，我们认为糖尿病肾病患者可能对氨基糖苷类药物敏感性增强，从而导致肾衰竭进展加速。
