Rangel Érika Bevilaqua
Hospital Israelita Albert Einstein, Instituto Israelita de Ensino e Pesquisa, São Paulo, SP, Brazil.
Universidade Federal de São Paulo, Departamento de Medicina, Divisão de Nefrologia, São Paulo, SP, Brazil.
J Bras Nefrol. 2025 Jan-Mar;47(1):e20240074. doi: 10.1590/2175-8239-JBN-2024-0074en.
Patients with diabetic kidney disease (DKD) face an elevated risk of experiencing acute kidney injury (AKI), exacerbating the progression of DKD. This article offers a comprehensive review of the literature and knowledge of the primary pathophysiologic mechanisms underlying kidney damage, as well as the biological implications of maladaptive kidney repair in the context of DKD complicated by AKI. Additionally, we examine in detail the findings of clinical trials evaluating the efficacy and safety of intensive insulin treatment for hyperglycemic patients in intensive care units, alongside the potential risks of hypoglycemia and mortality. Furthermore, through critical analysis of clinical trial results, opportunities for personalized safety-based approaches to mitigate side effects are identified. It is imperative to conduct randomized-controlled studies to assess the impact of intensive insulin treatment on diabetic patients with DKD, and to validate AKI biomarkers in this patient population. Such studies will help to tailor treatment strategies to improve patient outcomes and preserve kidney function.
糖尿病肾病（DKD）患者发生急性肾损伤（AKI）的风险升高，这会加剧DKD的进展。本文全面综述了肾脏损伤潜在的主要病理生理机制的文献和知识，以及在合并AKI的DKD背景下适应性不良的肾脏修复的生物学意义。此外，我们详细研究了评估重症监护病房中高血糖患者强化胰岛素治疗的疗效和安全性的临床试验结果，以及低血糖和死亡的潜在风险。此外，通过对临床试验结果的批判性分析，确定了基于个性化安全性方法减轻副作用的机会。必须进行随机对照研究，以评估强化胰岛素治疗对患有DKD的糖尿病患者的影响，并在该患者群体中验证AKI生物标志物。此类研究将有助于制定治疗策略，以改善患者预后并保护肾功能。
