摘要
Purpose To review evidence-based management of nephropathy in patients with type 2 diabetes.Data sources A literature search (MEDLINE 1966 to 2000) was performed using the key word 'diabetic nephropathy'. Relevant book chapters were also reviewed.Study selection Well-controlled, prospective landmark studies and expert review articles on diabetic nephropathy were selected.Data extraction Data and conclusions from the selected articles that provide solid evidence to the optimal management of diabetic nephropathy were extracted and interpreted in light of our clinical research experience with many thousands of Hong Kong Chinese patients.Results Hypertension, long diabetes duration, poor glycaemic control and central obesity are the most important risk factors. Microalbuminuria is a practical marker to predict overt nephropathy in type 2 diabetic patients. Risk factor modification, renal function monitoring and combined therapies are the current integrated approaches to manage patients with diabetic kidney disease. Optimal glycaemic control is the mainstay of treatment but effective antihypertensive therapy is also key to delaying the progression of diabetic nephropathy. Angiotensin-converting enzyme inhibitors and angiotensin Ⅱ receptor antagonists have important renoprotective actions independent of their blood pressure lowering actions. Conclusions Diabetic nephropathy is the leading cause of end-stage renal disease worldwide. Monitoring renal function and screening for microalbuminuria will allow the identification of patients with nephropathy at a very early stage for intervention. Tight glycaemic control and aggressive antihypertensive treatment as well as the use of renin-angiotensin system inhibitors should substantially delay the progression of nephropathy.
目的：与类型 2 糖尿病在病人考察 nephropathy 的基于证据的管理。数据采购原料：文学搜索(到 2000 的 MEDLINE 1966 ) 用关键词被执行“糖尿病的 nephropathy ”。相关的书章也被考察。学习选择：糖尿病的 nephropathy 上的控制得好的、未来的里程碑研究和专家评论文章被选择。数据抽取：从提供稳固的证据给糖尿病的 nephropathy 的最佳的管理的选择文章的数据和结论与许多几千个香港中国病人一起考虑到我们的临床的研究经验被提取并且解释。结果：高血压，长糖尿病持续时间，差的 glycaemic 控制和中央肥胖是最重要的风险因素。Microalbuminuria 是一个实际标记在类型 2 糖尿病的病人预言公开 nephropathy。风险因素修正，肾的功能监视和联合治疗是当前的综合途径与糖尿病的肾疾病管理病人。最佳的 glycaemic 控制是治疗的支柱但是高血压的治疗对推迟糖尿病的 nephropathy 的前进也关键的有效的反。变换血管收缩素的酶禁止者和血管收缩素 II 受体对手有独立于他们降低行动的血压的重要 renoprotective 行动。结论：糖尿病的 nephropathy 是结束阶段的领先的原因世界范围的肾的疾病。监视肾的功能并且为微蛋白尿屏蔽将为干预在一个很早的阶段与 nephropathy 允许病人的鉴定。紧密的 glycaemic 控制和好攻击的反高血压的治疗以及高血压蛋白原酶血管收缩素系统禁止者的使用应该实质地推迟 nephropathy 的前进。
