Rossing P
Steno Diabetes Center, Gentofte, Denmark.
Diabet Med. 1998 Nov;15(11):900-19. doi: 10.1002/(SICI)1096-9136(1998110)15:11<900::AID-DIA709>3.0.CO;2-0.
The scope of the present review is to discuss the prognosis of diabetic renal disease, putative progression promoters and the possibilities for treatment and prediction of treatment efficacy. The recent changes in the incidence of diabetic nephropathy in Type 1 diabetes mellitus are discussed. Promoters of progression in diabetic nephropathy are evaluated, in particular arterial blood pressure, glycaemic control, albuminuria and cholesterol levels. Potential treatment modalities are discussed, with special focus on antihypertensive therapy, including a discussion of a specific renoprotective action of certain antihypertensive agents. Furthermore putative predictors of treatment efficacy are evaluated, demonstrating that the ability to lower the urinary albumin excretion rate after onset of treatment heralds a slow progression of the renal disease. The prognosis in diabetic renal disease has improved with an increase in median survival after onset of nephropathy from 6 to 15 years. This has exposed the importance of cardiovascular morbidity and mortality. The identification and treatment of cardiovascular risk factors has become essential. Although the prognosis has improved remarkably, the primary goal should be prevention of diabetic nephropathy, as it is unlikely that the increased risks associated with this complication can be eliminated.
本综述的范围是讨论糖尿病肾病的预后、可能的病情进展促进因素以及治疗和预测治疗效果的可能性。文中讨论了1型糖尿病中糖尿病肾病发病率的近期变化。对糖尿病肾病进展的促进因素进行了评估，特别是动脉血压、血糖控制、蛋白尿和胆固醇水平。讨论了潜在的治疗方式，特别关注抗高血压治疗，包括对某些抗高血压药物特定肾脏保护作用的讨论。此外，还评估了治疗效果的可能预测指标，表明治疗开始后降低尿白蛋白排泄率的能力预示着肾病进展缓慢。糖尿病肾病的预后有所改善，肾病发作后的中位生存期从6年增加到了15年。这凸显了心血管疾病发病率和死亡率的重要性。识别和治疗心血管危险因素已变得至关重要。尽管预后有了显著改善，但主要目标仍应是预防糖尿病肾病，因为与该并发症相关的增加风险不太可能消除。
