Foote E F
Department of Pharmacy Practice and Administration, College of Pharmacy, Rutgers, State University of New Jersey, Piscataway 08855-0789, USA.
Am J Health Syst Pharm. 1995 Aug 15;52(16):1781-92. doi: 10.1093/ajhp/52.16.1781.
The pathophysiology and natural history of diabetic nephropathy are described, and recent developments in its prevention and treatment are discussed. Diabetic nephropathy can occur in both insulin-dependent and non-insulin-dependent diabetics. It is characterized by arterial hypertension, proteinuria, and progressive loss of renal function. Although the exact mechanism has not been fully elucidated, hyperglycemia with altered intraglomerular hemodynamics is an important contributor to the initiation and progression of the disease. Concurrent hypertension aggravates progression of the disease. Currently accepted strategies to slow the progression of diabetic renal disease have focused on antihypertensive therapy, strict glucose control, and restriction of dietary proteins. Recent publications support the hypothesis that angiotensin-converting-enzyme inhibitors have a unique ability, independent of their antihypertensive effect, to slow the progression of diabetic nephropathy. Investigational agents (e.g., aminoguanidine) may prove helpful in the management of the condition. Information about the prevention of diabetic nephropathy has grown significantly in the past few years.
本文描述了糖尿病肾病的病理生理学和自然病程，并讨论了其预防和治疗方面的最新进展。胰岛素依赖型和非胰岛素依赖型糖尿病患者均可发生糖尿病肾病。其特征为动脉高血压、蛋白尿以及肾功能的进行性丧失。尽管确切机制尚未完全阐明，但肾小球内血流动力学改变伴高血糖是该疾病发生和进展的重要因素。并发高血压会加重疾病进展。目前公认的减缓糖尿病肾病进展的策略主要集中在抗高血压治疗、严格控制血糖以及限制饮食蛋白质摄入。最近的出版物支持这样一种假说，即血管紧张素转换酶抑制剂具有独特能力，独立于其抗高血压作用之外，可减缓糖尿病肾病的进展。研究性药物（如氨基胍）可能对该病的治疗有帮助。在过去几年中，有关糖尿病肾病预防的信息有了显著增加。
