Friedman E A, Beyer M M
Klin Wochenschr. 1980 Oct 1;58(19):1023-8. doi: 10.1007/BF01476872.
Chronic uremia caused by diabetic glomerulopathy accounts for about 25 percent of new patients treated by maintenance hemodialysis. At the onset of glucose intolerance, insulin dependent diabetics have larger than normal kidneys, with a markedly increased glomerular filtration rate. During the subsequent 15 to 20 years of insulin use, glomerulosclerosis progresses silently, until a clinically overt nephrotic syndrome becomes evident. Thereafter, the clinical manifestations of nephropathy appear rapidly with an exponential decline in creatinine clearance to less than 5 ml/min within one to five years. Putting together a life plan for a nephrotic and azotemic diabetic involves awareness, and coordinated management of not only renal but extrarenal vasculopathic complications of diabetes, especially proliferative retinopathy. Carefully made preparations for hemodialysis and/or renal transplantation with increase changes for at least a short-term favorable outcome, which can now be anticipated in a growing proportion of patients.
糖尿病肾小球病所致的慢性尿毒症约占接受维持性血液透析治疗的新患者的25%。在糖耐量异常开始时，胰岛素依赖型糖尿病患者的肾脏比正常人大，肾小球滤过率显著增加。在随后使用胰岛素的15至20年中，肾小球硬化悄然进展，直至临床上明显出现肾病综合征。此后，肾病的临床表现迅速出现，肌酐清除率在1至5年内呈指数下降至低于5 ml/min。为患有肾病和氮质血症的糖尿病患者制定生活计划需要了解并协调管理糖尿病的肾脏及肾外血管病变并发症，尤其是增殖性视网膜病变。为血液透析和/或肾移植做好精心准备可增加至少短期内取得良好预后的机会，目前越来越多的患者有望实现这一目标。
