糖尿病腎病變治療新進展

Diabetic Nephropathy: Update in the Treatment

劉旅安(Lu-Ann Liu) ； 姜至剛(Chih-Kang Chiang)

《內科學誌》 30卷2期 (2019/04) Pp. 70-78

https://doi.org/10.6314/JIMT.201904_30(2).03

摘要

導致末期腎臟病變的原因眾多，其中糖尿病腎病變佔4成5且持續上升中。近來，許多大型研究提供臨床治療更多證據，本篇以實證醫學為觀點，提供更貼近臨床照護的準則，讓第一線照護醫師面對糖尿病腎病變有更好的依循，旨在探討糖尿病腎病變之最新治療原則。文中以血糖控制出發，繼之以致病機轉、治療選擇、可能有害、無效或待研究之治療為軸，提供適切建議，以達最佳治療建議。近來，針對SGLT-2抑制劑（Sodium-Glucose Cotransporter 2 Inhibitors，SGLT-2 Inhibitors）研究，發現其卓著的心腎保護效果亦詳加著墨，而其潛在治療風險也加強提醒，誠為本文重點。

關鍵字

蛋白尿（Proteinuria） ； 糖尿病腎病變（Diabetic nephropathy） ； 第二型鈉－葡萄糖轉運蛋白抑制劑（Sodium-glucose cotransporter 2 inhibitors） ； 酮酸中毒（Ketoacidosis）

並列摘要

Lots of etiologies cause end-stage renal disease (ESRD), and the percentiles of diabetic nephropathy (DN) - related ESRD are increasing up to 45% in Taiwan these years. Recently, there are several large clinical trials providing more rationales as treatment guidelines. First, this review stands on the evidence-based points of view, providing clinic care rules and state-of-the-art treatment for the primary care physician while facing the DN. Then, this article starts in the blood sugar control, and follows by the pathophysiology, treatment option, and the potential harmful or controversial treatment in DN. We hope to provide the most appropriate treatment suggestion for DN. Finally, we emphasize on the sound cardiorenal protection of sodium-glucose cotransporter 2 inhibitors (SGLT-2 Inhibitors), and also announce the potential adverse events, such as ketoacidosis and urogenital infection risks.