医学
蛋白尿
糖尿病
肾脏疾病
疾病
局灶节段性肾小球硬化
肾小球滤过
肾功能
重症监护医学
糖尿病肾病
肾单位
肾
内科学
蛋白尿
内分泌学
作者
Radica Z. Alicic,Michelle Nayahamui Rooney,Katherine R. Tuttle
出处
期刊:Clinical Journal of The American Society of Nephrology
[American Society of Nephrology]
日期:2017-05-18
卷期号:12 (12): 2032-2045
被引量:1656
摘要
Diabetic kidney disease develops in approximately 40% of patients who are diabetic and is the leading cause of CKD worldwide. Although ESRD may be the most recognizable consequence of diabetic kidney disease, the majority of patients actually die from cardiovascular diseases and infections before needing kidney replacement therapy. The natural history of diabetic kidney disease includes glomerular hyperfiltration, progressive albuminuria, declining GFR, and ultimately, ESRD. Metabolic changes associated with diabetes lead to glomerular hypertrophy, glomerulosclerosis, and tubulointerstitial inflammation and fibrosis. Despite current therapies, there is large residual risk of diabetic kidney disease onset and progression. Therefore, widespread innovation is urgently needed to improve health outcomes for patients with diabetic kidney disease. Achieving this goal will require characterization of new biomarkers, designing clinical trials that evaluate clinically pertinent end points, and development of therapeutic agents targeting kidney-specific disease mechanisms (e.g., glomerular hyperfiltration, inflammation, and fibrosis). Additionally, greater attention to dissemination and implementation of best practices is needed in both clinical and community settings.
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