早期糖尿病肾病:远远不止微量白蛋白尿

Early detection of diabetic nephropathy: far beyond microalbuminuria

糖尿病(DN)肾病是终末期肾脏病(ESRD)的主要病因之一,是导致糖尿病患者致残致死的主要病因之一。过去一直认为DN的发展经历经典的五期历程,微量白蛋白尿一直被认为是临床上早期监测DN起始的金标准,然而不断有研究发现,有些糖尿病患者没有蛋白尿或者仅有微量蛋白尿就直接进入肾功能下降期。那么经历经典分期的DN和直接进入肾功能下降的DN,二者在发病机制和治疗上有何不同?这些年来监测早期DN的新的生物标志物有哪些,分别又有什么特点呢?本文针对以上问题,做一分析。

Diabetic nephropathy (DN)is one of the leading causes of end-stage renal disease (ESRD)and the morbidity and mortality in patients with both types of diabetes.Before,the natural history of DN was believed to be a classical fivestage course,but accumulating evidence indicates that the clinical course of DN has changed.Some patients go through GFR loss independent of albuminuria or even in the absence of it.The aim of this review is to explore the difference between them,and to list some new biomarkers for the early detection of diabetic nephropathy.