Introduction of diabetic nephropathy

(修訂版本間差異)

跳轉到: 導航, 搜索

當前修訂版本

The most common cause of incident ESRD and the 2nd commonest cause of prevalent ESRD in Taiwan
Prevalence
- 40% in type 1 and 2 DM
- Because type 2 DM is much more common than type 1 DM, most diabetic nephropathy patients have type 2 DM
Importance of hyperglycemia in DN
- DCCT (Diabetes Control and Complications Trial)
  - Type 1 DM
  - NEJM 1993;329:977. The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus
- UKPDS (UK Prospective Diabetes Study)
  - Lancet 1998;352:837. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)
  - Type 2 DM
- Intensive glycemic control (HbA1C 6.5~7%) prevents microangiopathy in newly diagnosed DM, but effects on macroangiopathy (cardiovascular diseases and atherosclerosis) are less certain

 *** [http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-3TX4KPJ-3&_user=2411013&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000051939&_version=1&_urlVersion=0&_userid=2411013&md5=6ce6fc1e30dcd65072e0b0bc72934dff| Lancet 1998;352:837. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)]
 ***Type 2 DM
-**Intensive glycemic control prevents microangiopathy in newly diagnosed DM, but effects on macroangiopathy (cardiovascular diseases and atherosclerosis) are less certain
+**Intensive glycemic control (HbA1C 6.5~7%) prevents microangiopathy in newly diagnosed DM, but effects on macroangiopathy (cardiovascular diseases and atherosclerosis) are less certain
-*Other risk factors of DN
-**Hypertension (HT), proteinuria, smoking, hyperlipidemia, genetics (family history, renin-angiotensin gene polymorphism)