Manchester University Foundation Trust, Manchester, UK.
Sciarc GmbH, Baierbrunn, Germany.
Prim Care Diabetes. 2024 Dec;18(6):565-573. doi: 10.1016/j.pcd.2024.09.001. Epub 2024 Sep 15.
The prevalence of diabetes and chronic kidney disease (CKD) is increasing worldwide. Diabetic kidney disease is a chronic condition characterized by a gradual increase in urinary albumin excretion, blood pressure, cardiovascular risk, and a decline in glomerular filtration rate (GFR) that can progress to end-stage kidney disease (ESKD). Individuals with diabetes should be screened for CKD annually. Screening should include both measurement of albuminuria and estimation of GFR (eGFR). The structural changes in diabetic kidney disease in individuals with type 1 diabetes are rather uniform, but the histological picture in those with type 2 diabetes and CKD is on the contrary a mix of changes ranging from minor abnormalities to severe glomerulosclerosis, tubulointerstitial fibrosis, and arteriolohyalinosis. Scarring of the kidneys is closely related to the kidney function. Individuals with diabetes often require multiple therapies to prevent progression of CKD and its associated comorbidities and mortality. Management of cardiorenal risk factors, including lifestyle modification, control of blood glucose, blood pressure, and lipids, use of renin-angiotensin-aldosterone system (RAAS) blockers, use of sodium-glucose co-transporter 2 (SGLT2) inhibitors, and the non-steroidal mineralocorticoid receptor antagonist finerenone in individuals with T2D are the cornerstones of therapy. Primary care physicians (PCPs) play a critical role in identifying individuals with CKD, managing early stages of CKD, and referring those with moderate to severe CKD or rapidly declining kidney function to a nephrologist. Referral to a nephrologist should be considered when certain thresholds for eGFR, albuminuria, proteinuria, hematuria, or hypertension are exceeded. This review summarizes current guidelines for the management of CKD and its complications and highlights the role of PCPs in the care of individuals with CKD.
糖尿病和慢性肾脏病（CKD）的患病率在全球范围内不断增加。糖尿病肾病是一种慢性疾病，其特征为尿白蛋白排泄量逐渐增加、血压升高、心血管风险增加以及肾小球滤过率（GFR）下降，这些变化可能进展为终末期肾病（ESKD）。糖尿病患者应每年筛查 CKD。筛查应包括尿白蛋白和估计肾小球滤过率（eGFR）的测定。1 型糖尿病患者的糖尿病肾病的结构变化相当一致，但 2 型糖尿病和 CKD 患者的组织学图像相反，是从轻微异常到严重肾小球硬化、肾小管间质纤维化和血管玻璃样变等多种变化的混合体。肾脏的瘢痕与肾功能密切相关。糖尿病患者通常需要多种治疗方法来预防 CKD 的进展及其相关并发症和死亡率。管理心脏肾脏危险因素，包括生活方式改变、控制血糖、血压和血脂，使用肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂、钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂和非甾体类盐皮质激素受体拮抗剂非奈利酮，是治疗的基石。初级保健医生（PCP）在识别 CKD 患者、管理 CKD 早期阶段以及将中度至重度 CKD 或肾功能迅速下降的患者转介给肾病学家方面发挥着关键作用。当 eGFR、白蛋白尿、蛋白尿、血尿或高血压超过某些阈值时，应考虑将患者转介给肾病学家。这篇综述总结了 CKD 及其并发症的管理指南，并强调了 PCP 在 CKD 患者护理中的作用。
