糖尿病肾脏疾病诊疗中需要关注的几个问题  

Some issues deserving attention in the diagnosis and treatment of diabetic kidney disease

作　　者：陈晓君[1] 孙林[1] CHEN Xiao-jun;SUN Lin(Department of Nephrology,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院肾内科,湖南长沙410011

出　　处：《中国实用内科杂志》2025年第3期199-203,209,共6页Chinese Journal of Practical Internal Medicine

基　　金：湖南省自然科学基金委员会重大揭榜项目(2021JC0003)。

摘　　要：在糖尿病肾脏疾病(DKD)的临床诊治中,有几个易于被临床医师忽略的问题。首先,关于“糖尿病肾病(DN)”、“DKD”、“糖尿病合并慢性肾脏病”的不同名称的定义问题。DN指由糖尿病引起的肾脏特异性组织病理学变化,经肾活检证实。DKD通常用作非活检的临床诊断,目前使用广泛。糖尿病合并慢性肾脏病则指糖尿病患者合并所有类型CKD。其次,DKD患者肾功能一般呈缓慢下降,但部分患者估算肾小球滤过率(eGFR)持续下降每年>7 mL/(min·1.73 m^(2))或>4%,即可表现为快速进展型;而间质炎症患者常发生血尿;DKD新月体可能是受损肾小球壁层上皮细胞转分化为足细胞进行自我修复的过程中所形成,与炎性新月体有所不同,而预后较差。因此,关注并加强对上述DKD诊疗中几个特殊问题的认识,将有望提高该病的整体防治水平。There are some issues that are often neglected by clinicians in clinical diagnosis and treatment of diabetic kidney disease(DKD).Firstly,the definitions of diabetic nephropathy(DN),DKD,and diabetes mellitus in chronic kidney disease(DM in CKD)should be clarified.DN is characterized by kidney-specific histopathological changes due to DM,which is confirmed by biopsy.DKD,used for non-biopsy clinical diagnosis,is widely applied at present,while DMinCKD includes all CKD types in DM patients.Secondly,renal function in DKD patients usually declines slowly,but some patients experience continuous eGFR decline[>7 ml/(min·1.73 m^(2))per year or>4%per year],which presents as rapidly progressive type,and hematuria often occurs in patients with interstitial inflammation.DKD crescents,different from inflammatory crescents,may be formed during the self-repair process of injured glomerular cells differentiating into podocytes,and the prognosis is poor.Enhanced recognition of these issues is crucial for improving DKD's prevention and management.

关 键 词：糖尿病肾脏疾病 快速进展型糖尿病肾病 血尿 新月体 

分 类 号：R587.2[医药卫生—内分泌]