Danne T, Kordonouri O
Kliniken und Polikliniken für Kinderheilkunde und Kinderchirurgie, Charité-Virchow-Klinikum, Med. Fakultät, Humboldt Universität zu Berlin, Germany.
J Pediatr Endocrinol Metab. 1998 Apr;11 Suppl 2:347-63.
Between 5 and 20% of children with type 1 diabetes may develop microalbuminuria as a sign of incipient nephropathy starting in early puberty. Permanent microalbuminuria has to be distinguished from intermittent and transient microalbuminuria with unknown prognostic relevance. A review of clinical risk factors, retinal examination and an ambulatory 24-h blood pressure profile are recommended. Non-pharmacological interventions such as the improvement of glycemic control, the cessation of smoking or the feasibility of a low protein diet should always be considered. Concerning pharmacological intervention, in particular ACE-inhibitors have been shown to be beneficial in adolescents with hypertension but may also be renoprotective in normotensive patients with microalbuminuria. However, long-term studies with ACE-inhibitors in normotensive patients have shown negligible changes in the glomerular filtration rate, which better reflects the renal status during treatment than changes in the albumin excretion rate. Nevertheless, such treatment is currently recommended also for normotensive adolescents if other interventions are not successful.
1型糖尿病患儿中有5%至20%可能在青春期早期开始出现微量白蛋白尿，这是早期肾病的迹象。必须将持续性微量白蛋白尿与间歇性和短暂性微量白蛋白尿区分开来，后者的预后相关性尚不清楚。建议对临床危险因素进行评估、进行视网膜检查并记录24小时动态血压。应始终考虑非药物干预措施，如改善血糖控制、戒烟或低蛋白饮食的可行性。关于药物干预，特别是血管紧张素转换酶抑制剂（ACE抑制剂）已被证明对患有高血压的青少年有益，但对有微量白蛋白尿的血压正常患者也可能具有肾脏保护作用。然而，对血压正常患者使用ACE抑制剂的长期研究表明，肾小球滤过率的变化微不足道，与白蛋白排泄率的变化相比，肾小球滤过率的变化能更好地反映治疗期间的肾脏状况。尽管如此，如果其他干预措施无效，目前也建议对血压正常的青少年进行此类治疗。
