糖尿病肾病发病机制的研究进展

糖尿病肾病( diabetic nephropathy,DN)是糖尿病(diabetes mellitus,DM)最主要的微血管并发症,近年来,DN已成为世界范围内导致终末期肾病(end stage renal disease,ESRD)的首位病因.在我国,DN发病率也逐年上升,成为仅次于慢性肾炎引起ESRD的第二大原因,严重地影响了人们的健康水平.DN患者体内复杂的代谢紊乱、肾脏血流动力学的改变及一些细胞因子的产生使其比其他肾脏病的治疗更加棘手,因此,进一步研究DN的发病机制,制定更有效的防治措施,是当前糖尿病和肾脏病领域十分急迫的课题.     

选择性环氧化酶2抑制剂在糖尿病肾病中的研究进展

糖尿病肾病(DN)已成为西方国家终末期肾病(ESRD)的主要病因，亦是发展中国家ESRD的最常见原因，当前主要治疗措施在于血糖和血压的控制，一般治疗包括控制体重、调脂、禁烟、低盐饮食等。一些新的治疗方法，包括选择性抑制剂的使用正在不断地探索中。本文就选择性环氧化酶2(COX-2)抑制剂在DN中的治疗进展作一综述。     

糖尿病肾病的蛋白质组学研究进展

糖尿病肾病(DN)是糖尿病最常见的微血管并发症,也是导致终末期肾病(ESRD)的重要原因。微量白蛋白尿作为预测DN进展的指标并不可靠,寻找DN早期生物学标志物以及对DN早期肾脏病变的机制研究为目前研究的重点。蛋白质组学技术近年来飞速发展,对DN患者的尿液、血液以及肾组织的蛋白质组学研究可能会为我们早期诊治DN提供新的希望。本文对蛋白质组学主要技术及DN蛋白质组学研究的近期研究进展进行综述。     

胰岛素抵抗及其对糖尿病肾病作用的新认识

糖尿病肾病(DN)是糖尿病最重要和最常见的并发症之一,1型和2型糖尿病患者中DN的发生率约为35%[1].同时DN也是终末期肾脏疾病(ESRD)的重要原因,虽然我国大陆DN仅占ESRD的5%,但在生活水平较高的地区如日本却高达28%[2].随着我国经济水平的提高,糖尿病发病率逐年上升,DN可能会成为导致ESRD的主要原因.人类对胰岛素抵抗(IR)的认识始于半个多世纪前对糖尿病的研究,2型糖尿病普遍存在IR早已定论.IR是多种疾病,特别是糖尿病及心血管疾病的共同危险因素,进一步认识DN与IR的关系,有效防治DN及其并发的心血管疾病是当前糖尿病和肾脏病领域共同面临的重要课题.     

结缔组织生长因子与糖尿病肾病

糖尿病肾病(DN)是糖尿病最主要的慢性并发症之一,在西方国家已成为终末期肾病(ESRD)的首要病因[1].其发病机制迄今未明.一般认为与高血糖及其引起的代谢紊乱、肾小球血流动力学改变等因素有关.近年来,某些生长因子在DN发病机制中的作用越来越受到重视.其中,结缔组织生长因子(CTGF)作为转化生长因子β(TGF-β)促纤维化活性的下游效应因子而备受关注.     

microRNA在糖尿病肾病中作用的研究进展

糖尿病肾病(DN)是糖尿病患者最常见的微血管并发症.在欧美等发达国家,DN已成为终末期肾病(ESRD)的首要病因.在我国,因DN而最终导致ESRD的比例也在逐年上升.DN的早期诊断和合理的治疗可有效地延缓疾病进展.因此,深入认识DN的发病机制,并对其发病的关键环节进行干预,不仅可减轻疾病给患者带来的痛苦,对减轻国家在卫生经济费用方面的负担也有重要意义.目前DN的发病机制仍未完全明确,近年有研究发现microRNA(miRNA)在基因中的调控作用可能成为DN一个新的诊断标志及治疗靶点[1].本文就miRNA在DN中的作用及相关机制进行综述.     

体液 miRNAs：糖尿病肾病早期的潜在性生物标志物

糖尿病肾病（diabetic nephropathy,DN）又称糖尿病肾小球硬化症,是1型和2型糖尿病主要的微血管并发症,也是引起终末期肾脏病（ESRD）的重要病因之一。近年来,随着全球范围内的糖尿病患者日趋增多,在西方国家 DN 已成为导致ESRD 的首要病因,在我国这一比例也在逐年递增。在 DN 的发病早期主要表现为微量白蛋白尿（尿白蛋白排泄率30~300 mg／ d）,而大量蛋白尿（尿白蛋白排泄率〉300 mg／ d）则预示该疾病的持续性恶化［1］。一旦进展至 ESRD 阶段时,很多患者须采取肾脏替代疗法,即透析或肾移植。可见,对早期DN 给予有效诊断及治疗,对于延缓疾病进展具有重要意义。     

终末期糖尿病肾病的中医药治疗研究进展

<正>糖尿病肾病(diabetic nephropathy,DN)是糖尿病(diabetes mellitus,DM)严重的慢性微血管并发症之一[1,2],是终末期肾病(end stage renal disease,ESRD)较为常见的原发病因。2型糖尿病患者人群中患DN者占34.7%,而因DN导致死亡者约占糖尿病患者的30%[3]。由于其起病缓慢,早期容易忽略,许多患者一经确诊,都已是DNⅢ期或Ⅳ期。迄今为止,西医治疗DN的主要手段是强化血糖控制,降压,调整脂质代谢及优     

糖尿病肾病进展风险及预后评估的研究进展

近30年来,糖尿病(DM)患病率逐年升高。据国际糖尿病联盟统计,2011年世界DM人数约3.66亿,估计到2030年DM人数将增加到5.52亿。其中48%的增长发生在中国和印度[1]。糖尿病肾病(DN)是DM患者最常见、最严重的慢性微血管并发症,目前已成为西方国家终末期肾脏病(ESRD)的首位病因,亦是我国ESRD的主要病因。DN患者一旦进展到明     

中医药治疗糖尿病肾病研究现况

糖尿病肾病（diabetic nephropathy,DN）是糖尿病最常见的并发症之一,也是导致肾衰竭的重要病因。糖尿病肾病占我国终末期肾脏病（end-stage renal disease,ESRD）的16.4%,可能未来会成为我国ESRD的首位病因。     

糖尿病肾病研究进展

糖尿病肾病是糖尿病最严重的微血管并发症。近10年来,糖尿病肾病患者快速增长,已成为危害人类健康的公共卫生疾病。目前在欧美等发达国家,DN约占终末期肾病(ESRD)的50%,已成为尿毒症的首位原发病;在我国约占25%～40%,是患者血液透析的重要原因。因此,及时发现与防治DN,对于延缓病情进展、提高患者生活质量意义重大。     

Meta-analysis of the relationship between ACE I/D gene polymorphism and end-stage renal disease in patients with diabetic nephropathy

Aims: Diabetic nephropathy (DN) is the major cause for end‐stage renal disease (ESRD) and the pathogenesis for DN developing into ESRD is not clear at present. Results from published studies on the relationship between angiotensin‐converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and ESRD risk in DN patients are still conflicting. This meta‐analysis was performed to evaluate the association between ACE I/D gene polymorphism and ESRD risk in DN patients. Methods: Association studies were identified from the databases of PubMed, Embase and Cochrane Library on 1 October 2011, and eligible investigations were identified and synthesized using the meta‐analysis method. Results were expressed using odds ratios (OR) for dichotomous data and 95% confidence intervals (CI) were also calculated. Results: Twelve studies reporting the relation between ACE I/D gene polymorphism and ESRD risk in DN patients were identified. In overall populations, there was a notable association between D allele or DD genotype and ESRD susceptibility (D: OR = 1.32, 95% CI: 1.11–1.56, P = 0.002; DD: OR = 1.67, 95% CI: 1.25–2.21, P = 0.0004). In the sub‐group analysis according to ethnicity, D allele or DD genotype was associated with ESRD risk in Asians. In Caucasians, the association of DD genotype with ESRD risk was observed, but the D allele was not. Furthermore, ACE I/D gene polymorphism was associated with ESRD risk in patients with DN due to diabetes mellitus type 2, but the association was not found for patients with DN due to diabetes mellitus type‐1. Conclusions: Our results indicate that D allele or DD homozygous is associated with the ESRD susceptibility in DN patients. However, more investigations are required to further this association.     

Diabetics on hemodialysis in El-Minia Governorate,Upper Egypt: five-year study

Introduction  

The number of patients with end-stage renal disease (ESRD) due to diabetic nephropathy (DN) is increasing worldwide. In many countries, diabetes mellitus has become the most frequent cause of ESRD. The goal of this work is to critically evaluate the prevalence of DN among chronic regular hemodialysis (HD) patients in El-Minia Governorate, to evaluate changes over the course of 5 years, and to compare data of El-Minia Governorate with data from the United States and other countries, in an attempt to detect factors that might explain causes of the differences.     

Trends in the incidence of treated end-stage renal disease secondary to diabetic nephropathy: 1975-1984

A study of the incidence of treated end-stage renal disease (ESRD) secondary to diabetic nephropathy (DN) in Missouri from 1975 to 1984 documented a relative risk of treated ESRD due to DN 3.7 times higher for blacks than whites. Between 1980 and 1984, the incidence rate for treated ESRD due to DN increased by 150% for white patients and 315% for black patients. Blacks over age 50 have incidence rates of treated ESRD due to DN 4.9 times their white counterparts. Black females have the highest rate of all race/sex groups with DN. The escalating high risk of older blacks for treated ESRD due to DN mandates the development of effective community based identification and referral efforts.     

Progression of coronary artery calcification in diabetics with and without chronic kidney disease

BACKGROUND: Rapid progression of coronary artery calcification (CAC) has been reported among individuals with end-stage renal disease (ESRD). There is limited information on the progression of CAC during earlier stages of diabetic chronic kidney disease (CKD). METHODS: In a prospective, cohort study of type 2 diabetic individuals (N = 90; normoalbuminuric diabetic controls, 30; diabetic nephropathy, DN, 60), electron-beam computed tomography (EBCT) was repeated at an average interval of 19 months. All scan images were acquired at end-systole to minimize interscan variability. In order to eliminate the dependence of the residual error from interscan variability on baseline CAC scores, square root transformed CAC scores were used for analyses of progression of coronary calcification. RESULTS: Repeat EBCT scans were completed in 68 subjects (diabetic controls: 23; DN: 45). There was a highly significant relationship between the proportion of subjects with progressive CAC and renal disease-DN who progressed to ESRD, 80%; DN who did not progress to ESRD, 30%; and diabetic controls, 13% (P < 0.001). Similarly, the magnitude of change was significantly related to renal disease (DN who progressed to ESRD > DN who did not progress to ESRD > diabetic controls, P < 0.001). Using logistic regression and controlling for non-dialyzed DN, ESRD and inter-scan interval, advanced age was the only significant variable associated with progression of CAC. Finally, serum creatinine and baseline CAC score emerged as independent predictors for the magnitude of increase in CAC. CONCLUSION: Progression of CAC is apparent among individuals with DN both before and after ESRD. However, the risk factors associated with progression of CAC may differ at different stages of CKD.     

Enhancing the predictive value of urinary albumin for diabetic nephropathy

Diabetic nephropathy (DN) is a growing cause of ESRD despite widely known recommendations for improved glycemic and BP control. Perhaps earlier identification of patients who have diabetes and are at high risk for DN could reverse these epidemiologic trends. Albumin excretion rate (AER), the mainstay of early detection of DN, is not a sufficiently precise predictor of DN risk. Careful family history, smoking history, consideration of absolute versus categorical AER values, more frequent AER measures, ambulatory BP monitoring, precise GFR measurements, diabetic retinopathy assessments, and plasma lipid levels all can add to predictive accuracy for DN. Thus, although further research in DN biomarkers and predictors is greatly needed, a careful integrated evaluation of currently available parameters can improve our ability to predict DN risk in individual patients.     

Rate of change of end-stage renal disease treatment incidence 1978-1987--has there been selection?

End-stage renal disease (ESRD) treatment rates in the United States have increased steadily since 1973. Decreasing selection against elderly patients with a poor prognostic primary cause of ESRD (i.e., diabetic nephropathy) may partly account for this increase in rates. To test this hypothesis, we calculated log ESRD treatment incidence (ESRDI) rates by four major primary causes of ESRD (diabetic nephropathy (DN), hypertensive nephropathy (HN), glomerulonephritis (GN), and cystic kidney disease (PC); two age groups (old (O), greater than 65 and young (Y), 15 to 44 yr of age) for black and white, male and female, new ESRD patients from 1978 to 1987. As predicted, summary log ESRDI slopes (produced by analysis of covariance) occurred in the following decreasing order, ODN (0.19), OGN = OHN = YDN (0.134). YHN = YPC = YGN (in white patients) = slope not significantly different from 0. Log ESRDI slopes for young black males and females with GN increased significantly between 1978 and 1987, possibly as a result of an increased incidence of GN. In conclusion, decreasing selection may be a factor in the continuing increase in the U.S. ESRD population.     

糖尿病肾病患者口服降糖药应用进展

糖尿病肾病已成为全球终末期肾病的最主要病因之一。严格控制血糖可以有效减少糖尿病肾病发生及疾病进展;然而随着肾功能减退,会出现体内降糖药物蓄积,增加药物毒副反应及低血糖事件,所以糖尿病肾病患者如何有效且安全的使用口服降糖药物至关重要。本文主要讨论各类口服降糖药物包括胰岛素促泌剂、非胰岛素促泌剂及新型口服降糖药物在糖尿病肾病中的应用。     

Renal replacement therapy for diabetic end-stage renal disease: data from 10 registries in Europe (1991-2000)

BACKGROUND: There is concern about the rising prevalence of type 2 diabetes mellitus and of the resultant nephropathy. This study uses data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry to provide information on the epidemiology and outcome of renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to diabetic nephropathy (DN). METHODS: Data from the following 10 registries: Austria, French-speaking Belgium, Denmark, Finland, Greece, Norway, Scotland (UK), Catalonia (Spain), Sweden, and The Netherlands were combined. Average annual changes (%) were estimated by Poisson regression. Analyses of mortality were performed by Cox regression. RESULTS: An increase in patients with type 2 DN entering RRT has been observed (+11.9% annually, P < 0.05), while large differences in RRT incidence in this disease continue to exist between countries in Europe. There was a reduction in mortality during the first 2 years on dialysis therapy among patients with type 2 DN (AHR 0.96, 95%CI 0.94-0.97 annually). The mortality among transplant recipients decreased for both type 1 DN and nondiabetic ESRD (non DN) within the 1995-1998 cohort (type 1 DN: AHR 0.49, 95% CI 0.35-0.68; non DN: AHR 0.79, 95% CI 0.69-0.90) compared to the 1991-1994 cohort. CONCLUSION: This report has shown that during the last decade there has been a marked increase in the incidence of RRT for type 2 DN. Survival analysis showed that over the period 1991-1999 the mortality rates of all dialysis patients and of type 1 diabetic and nondiabetic renal transplant recipients have fallen.