临床糖尿病肾病:自然史和并发症

A. Grenfell, P.J. Watkins
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引用次数: 65

摘要

1.约45%的胰岛素依赖型糖尿病患者会发展为糖尿病肾病,其中三分之二会发展为肾衰竭,其余的则死于心血管疾病。大多数胰岛素依赖型糖尿病患者的超额死亡率发生在蛋白尿患者身上。在非胰岛素依赖型糖尿病患者中,肾病也是死亡率增加的一个重要原因,但这主要来自心血管疾病。一旦糖尿病肾病确立,它会持续发展到终末期肾功能衰竭,持续时间约为7年,但从5年到20年不等。个别病人的不同进展速度的原因尚不清楚。高血压合并糖尿病肾病,其治疗可延缓肾功能衰竭的进展。其他形式的干预包括控制血糖,但没有显示出任何效果,以及限制蛋白质,目前还没有结论。糖尿病肾病的诊断是直截了当的存在一个典型的历史和临床特征。非糖尿病性肾脏疾病有时是肾功能衰竭的原因,可能需要特殊治疗;肾功能衰竭治疗的预后可能比合并其他糖尿病并发症的肾病患者好。其他糖尿病并发症随着糖尿病肾病的进展而发展,最明显的是心脏和周围血管疾病。增殖性视网膜病变和神经病变是相当大的问题,其管理需要注意在肾功能衰竭治疗前后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical diabetic nephropathy: Natural history and complications

  • 1.

    Diabetic nephropathy develops in about 45% of insulin dependent diabetics of whom two-thirds will develop renal failure, the rest dying from cardiovascular disease.

  • 2.

    Most of the excess mortality of insulin dependent diabetics occurs in those with proteinuria.

  • 3.

    Among non-insulin dependent diabetics nephropathy is also an important cause of increased mortality but this is mainly from cardiovascular disease.

  • 4.

    Once diabetic nephropathy is established it progresses relentlessly to end-stage renal failure over about seven years, but ranging from five to 20 years. The explanation for the different rates of progression in individual patients is not understood.

  • 5.

    Hypertension accompanies diabetic nephropathy and its treatment may retard the progression of renal failure.

  • 6.

    Other forms of intervention include glycaemic control which has not been shown to have any effect, and protein restriction for which no conclusions can be drawn at present.

  • 7.

    The diagnosis of diabetic nephropathy is straightforward in the presence of a typical history and clinical features. Non-diabetic renal disease is sometimes the cause of renal failure and may require specific treatment; prognosis for renal failure treatment may be better than for nephropathy patients with other diabetic complications.

  • 8.

    Other diabetic complications develop as diabetic nephropathy progresses, most notably cardiac and peripheral vascular disease. Proliferative retinopathy and neuropathy are considerable problems and their management needs attention both before and after renal failure treatment.

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