Mogensen C E
Medical Department M, Aarhus Kommunehospital, University Hospitals, Denmark.
Annu Rev Med. 1995;46:79-93. doi: 10.1146/annurev.med.46.1.79.
Diabetic patients go through several stages of renal disease, moving from normo- to micro- to macroalbuminuria. Good metabolic control can prevent or postpone the development of microalbuminuria, the earliest sign of diabetic renal disease. Thus, efforts should focus on obtaining the best possible control before the onset of microalbuninuria. In patients with microalbuminuria, blood pressure starts to increase, and early antihypertensive treatment becomes important. Good glycemic control may be difficult to achieve. With overt nephropathy, defined as clinical proteinuria, a relentless decline in glomerular filtration rate (GFR) occurs unless patients are carefully treated with antihypertensive agents. Protein restriction may also be necessary, but a clear beneficial effect of optimized diabetes care is difficult to document. Early screening is recommended, with an emphasis on testing for albuminuria, including microalbuminuria, along with careful control of blood pressure.
糖尿病患者会经历几个肾病阶段，从正常白蛋白尿发展到微量白蛋白尿再到大量白蛋白尿。良好的代谢控制可以预防或推迟微量白蛋白尿的出现，微量白蛋白尿是糖尿病肾病的最早迹象。因此，应努力在微量白蛋白尿出现之前实现尽可能最佳的控制。在微量白蛋白尿患者中，血压开始升高，早期抗高血压治疗变得很重要。良好的血糖控制可能难以实现。对于显性肾病，即临床蛋白尿，除非患者接受抗高血压药物的仔细治疗，否则肾小球滤过率（GFR）会持续下降。可能也需要限制蛋白质摄入，但优化糖尿病护理的明确有益效果很难证明。建议进行早期筛查，重点是检测白蛋白尿，包括微量白蛋白尿，同时要仔细控制血压。
