Bartos V
Institut klinické a experimentální medicíny, Praha 4.
Vnitr Lek. 1998 Apr;44(4):237-9.
Diabetic nephropathy is a serious microangiopathic complication of diabetes type I and II, which accounts for a marked proportion of the high morbidity and invalidity of diabetics. Although when the disease is fully developed, progression is inevitable, ther are ways how to prevent its development and retard its course. Because reliable prediction of diabetic nephropathy is not possible, primary prevention is essential in all diabetics. It involves, as soon as the diagnosis of diabetes is established, systematic checks of the blood sugar level and permanent satisfactory compensation of diabetes (HbA1c less than 6.5%) which is the main principle during the whole subsequent course of the disease. The principle of secondary prevention the purpose of which is to prevent the development of manifest nephropathy with permanent proteinuria is monitoring of microalbuminuria and maintenance of a normal blood pressure. With regard to pathophysiological associations, in the treatment angiotensin-converting enzymes inhibitors are preferred. The objective of tertiary prevention is to delay renal insufficiency by fortified hypotensive therapy, correction of hyperlipoproteinaemia, dietary protein restriction and satisfactory compensation of diabetes. In case of renal failure dialyzation treatment or transplantation must not be delayed.
糖尿病肾病是I型和II型糖尿病严重的微血管并发症，在糖尿病患者的高发病率和致残率中占显著比例。尽管疾病充分发展后进展不可避免，但仍有方法可预防其发生并延缓病程。由于无法可靠预测糖尿病肾病，因此对所有糖尿病患者而言，一级预防至关重要。一旦确诊糖尿病，即应进行血糖水平的系统检查，并持续将糖尿病控制在满意水平（糖化血红蛋白低于6.5%），这是疾病后续整个过程的主要原则。二级预防的目的是预防出现明显肾病伴持续性蛋白尿，其原则是监测微量白蛋白尿并维持正常血压。鉴于病理生理关联，治疗时首选血管紧张素转换酶抑制剂。三级预防的目标是通过强化降压治疗、纠正高脂蛋白血症、限制饮食蛋白质摄入以及将糖尿病控制在满意水平来延缓肾功能不全。一旦出现肾衰竭，不得延误透析治疗或移植。
