Cooper M E
Department of Medicine, University of Melbourne, Austin and Repatriation Medical Centre (Repatriation Campus), West Heidelberg, VIC, Australia.
Lancet. 1998 Jul 18;352(9123):213-9. doi: 10.1016/S0140-6736(98)01346-4.
It is likely that the pathophysiology of diabetic nephropathy involves an interaction of metabolic and haemodynamic factors. Relevant metabolic factors include glucose-dependent pathways such as advanced glycation, increased formation of polyols, and activation of the enzyme, protein kinase C. Specific inhibitors of the various pathways are now available, enabling investigation of the role of these processes in the pathogenesis of diabetic nephropathy and potentially to provide new therapeutic approaches for the prevention and treatment of diabetic nephropathy. Haemodynamic factors to consider include systemic hypertension, intraglomerular hypertension, and the role of vasoactive hormones, such as angiotensin II. The mainstay of therapy remains attaining optimum glycaemic control. Antihypertensive therapy has a major role in slowing the progression of diabetic nephropathy. Agents that interrupt the renin-angiotensin system such as angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists may be particularly useful as renoprotective agents in both the hypertensive and normotensive context.
糖尿病肾病的病理生理学可能涉及代谢和血流动力学因素的相互作用。相关的代谢因素包括葡萄糖依赖性途径，如晚期糖基化、多元醇生成增加以及蛋白激酶C酶的激活。现在已有各种途径的特异性抑制剂，这使得人们能够研究这些过程在糖尿病肾病发病机制中的作用，并有可能为糖尿病肾病的预防和治疗提供新的治疗方法。需要考虑的血流动力学因素包括全身性高血压、肾小球内高血压以及血管活性激素如血管紧张素II的作用。治疗的主要手段仍然是实现最佳血糖控制。抗高血压治疗在减缓糖尿病肾病进展方面起着重要作用。诸如血管紧张素转换酶抑制剂和血管紧张素II受体拮抗剂等干扰肾素-血管紧张素系统的药物，在高血压和血压正常的情况下作为肾脏保护剂可能特别有用。
