Gohda Tomohito, Hagiwara Shinji, Abe Kenichiro, Hirose Hitomi, Shimozawa Kenta, Kishida Chiaki, Sakuma Hiroko, Adachi Eri, Koshida Takeo, Suzuki Yusuke, Murakoshi Maki
Juntendo Iji Zasshi. 2024 Dec 31;70(6):408-415. doi: 10.14789/ejmj.JMJ24-0031-P. eCollection 2024.
Chronic kidney disease (CKD) attributed to diabetes, termed diabetic kidney disease (DKD), is increasing with the rising global prevalence of diabetes. Patterns of DKD onset and progression have shifted in recent years because of population aging and advances in the treatment of diabetes. Prevention of the onset and progression of micro/macro-albuminuria is possible through comprehensive and strict management of lifestyle, blood glucose, blood pressure, and lipids in people with diabetes and early DKD. Renin-angiotensin system (RAS) inhibitors have also been shown to effectively slow the progression of CKD in people with diabetes and micro/macro-albuminuria. However, the effect of improving kidney outcomes with RAS inhibitors in people with advanced DKD is limited, and the residual risk remains very high. A recent rapid expansion of treatment options include sodium-glucose co-transporter-2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists, which have demonstrated additional protective effects for the kidneys when used in addition to the standard therapy with RAS inhibitors, even in people with advanced DKD. Early diagnosis and therapeutic intervention can be expected to delay progression to end-stage kidney failure. This perspective outlines the diagnostic and therapeutic evolution of DKD to date.
由糖尿病引起的慢性肾脏病（CKD），即糖尿病肾病（DKD），随着全球糖尿病患病率的上升而增加。由于人口老龄化和糖尿病治疗的进展，近年来DKD的发病和进展模式已经发生了变化。通过对糖尿病患者和早期DKD患者的生活方式、血糖、血压和血脂进行全面而严格的管理，可以预防微量/大量白蛋白尿的发生和进展。肾素-血管紧张素系统（RAS）抑制剂也已被证明能有效减缓糖尿病合并微量/大量白蛋白尿患者的CKD进展。然而，RAS抑制剂改善晚期DKD患者肾脏结局的效果有限，残余风险仍然很高。最近治疗选择迅速扩展，包括钠-葡萄糖协同转运蛋白2抑制剂、非甾体盐皮质激素受体拮抗剂和胰高血糖素样肽1受体激动剂，这些药物在与RAS抑制剂标准治疗联合使用时，即使是晚期DKD患者，也已证明对肾脏有额外的保护作用。早期诊断和治疗干预有望延缓进展至终末期肾衰竭。本观点概述了迄今为止DKD的诊断和治疗进展。
