糖尿病腎病變的診斷與治療

Diagnosis and Management of Diabetic Kidney Disease (DKD)

楊翼寧(I-Ning Yang) ； 陳銳溢(Jui-Yi Chen) ； 王憲奕(Hsien-Yi Wang) ； 鄭高珍(Kuo-Chen Cheng)

《內科學誌》 29卷4期 (2018/08) Pp. 240-249

https://doi.org/10.6314/JIMT.201808_29(4).05

摘要

糖尿病腎病變（Diabetic Kidney Disease, DKD）是導致末期腎病變（End Stage Renal Disease, ESRD）最主要的原因，也是世界各國都非常重視的公衛議題，因它為個人和整體社會經濟都帶來嚴重的負面影響。過去幾十年來在糖尿病腎病變的領域有許多觀念的變革與藥物的發展，因此重新認識糖尿病腎病變乃為此篇的宗旨。本文會從多個面向介紹糖尿病腎病變，包括流病分析：世界與台灣的現況、定義及分類：2007 KDOQI與2013 KDIGO臨床指引、適當的篩檢與轉介時機、自然史與分期、蛋白尿與腎功能異常的迷思、診斷流程、目前的治療策略：多方面介入及血糖血壓控制的新思惟、和最新藥物的發展。

關鍵字

糖尿病腎病變(Diabetic kidney disease, DKD) ； 末期腎病變(End stage renal disease, ESRD) ； 微白蛋白尿(Microalbuminuria, MA) ； SGLT-2 抑制劑(Sodium-glucose cotransporter 2 inhibitors, SGLT-2 Inhibitors) ； RAAS 抑制劑(Renin-angiotensin-aldosterone system inhibitors, RAAS Inhibitors)

並列摘要

Diabetic kidney disease (DKD), the major cause of end stage renal disease (ESRD), has substantial individual and socioeconomic consequences worldwide. In the past couple of decades, there have been notable developments in the field of DKD. Hence, the goal of this article is to summarize recent updates and provide a comprehensive review on the diagnosis and management of DKD. Sections described include the current epidemiology and medicare burden of DKD in Taiwan, natural history of DKD: from risk to failure, clinical definition and detection of DKD based on 2007 NKF-KDOQI and 2013 KDIGO guidelines, adequate screening and referral time, evolving presentation of DKD: in a more heterogeneous manner, contemporary proven therapies involving non-pharmacological interventions and new insights of glycemic/blood pressure control, and potential future treatments studies in phase 3 clinical trials such as endothelin-1 receptor A antagonists (Atrasentan), non-steroidal mineralocorticoid receptor antagonists (Finerenone), TGF-β inhibitors (Pirfenidone), phosphodiesterase inhibitors (Pentoxiphylline), and 5-HT 2a receptor antagonists (Sarpogrelate). It is expected that the article will help non-nephrology health care practitioners to diagnose and manage patients with DKD.