Earle K, Viberti G C
Unit for Metabolic Medicine, United Medical School, Guy's Hospital, London, England, United Kingdom.
Kidney Int. 1994 Feb;45(2):434-7. doi: 10.1038/ki.1994.56.
Proteinuric diabetic patients have an increased risk of cardiovascular disease and almost always have hypertension. In the early stages of diabetic renal disease (microalbuminuria) when renal function is well preserved, systemic arterial blood pressure is already elevated compared to insulin-dependent diabetic patients without microalbuminuria. Prospective studies have shown that normoalbuminuric patients who progress to microalbuminuria have higher blood pressures (albeit within the normal range) than those who persistently remain normoalbuminuric. Parents of insulin-dependent diabetic patients with nephropathy have a higher prevalence of hypertension and cardiovascular disease compared to those of patients without nephropathy. Moreover, diabetic nephropathy clusters within families. Erythrocyte sodium-lithium countertransport activity, the most consistent marker for essential hypertension and its cardiorenal complications, is elevated in diabetic patients with nephropathy and in their non-diabetic parents. These data suggest that a familial predisposition to arterial hypertension and cardiovascular disease increases the risk for the development of nephropathy and its associated cardiovascular complications in insulin-dependent diabetes. Arterial hypertension is a state of insulin resistance and diabetic patients susceptible to nephropathy have been found to be less insulin sensitive. Preventive strategies of diabetic kidney disease in the future will have to take into account its metabolic hemodynamic and familial basis.
蛋白尿性糖尿病患者患心血管疾病的风险增加，且几乎总是患有高血压。在糖尿病肾病的早期阶段（微量白蛋白尿），当肾功能保存良好时，与无微量白蛋白尿的胰岛素依赖型糖尿病患者相比，系统性动脉血压已经升高。前瞻性研究表明，进展为微量白蛋白尿的正常白蛋白尿患者比持续保持正常白蛋白尿的患者血压更高（尽管在正常范围内）。与无肾病患者的父母相比，患有肾病的胰岛素依赖型糖尿病患者的父母患高血压和心血管疾病的患病率更高。此外，糖尿病肾病在家族中聚集。红细胞钠-锂逆向转运活性是原发性高血压及其心肾并发症最一致的标志物，在患有肾病的糖尿病患者及其非糖尿病父母中升高。这些数据表明，家族性动脉高血压和心血管疾病易感性增加了胰岛素依赖型糖尿病患者发生肾病及其相关心血管并发症的风险。动脉高血压是一种胰岛素抵抗状态，已发现易患肾病的糖尿病患者胰岛素敏感性较低。未来糖尿病肾病的预防策略将不得不考虑其代谢、血液动力学和家族基础。
