Die diabetische Nephropathie ist neben der vaskulären Nephropathie die häufigste Nierenerkrankung
in den entwickelten Industriestaaten. Die wichtigsten Faktoren für ihre Entstehung
sind genetische Prädisposition, arterielle Hypertonie und Hyperglykämie. Eine Prävention
ist nur durch eine frühzeitige Optimierung von Blutdruck und Blutzucker – praktisch
unmittelbar nach Stellung der Diabetesdiagnose möglich. Für die Progressionshemmung
hat sich die Blutdruckoptimierung als entscheidend erwiesen, eine normnahe Blutzuckereinstellung
ist dabei eher von nachgeordneter Bedeutung.
Diabetic nephropathy has become the most common cause of end stage renal disease in
the industrialized countries. Genetic background, hyperglycemia and hypertension are
important causative factors, whereas the latter one is also responsible for disease
progression. An early optimal treatment of hypertension and hyperglycemia accompanied
by life style modification are the best therapeutic strategies to prevent diabetic
kidney damage. Once diabetic nephropathy has been occurred, an optimal blood pressure
control is mandatory and its effect is superior over blood glucose control.
Key words
diabetic nephropathy - microalbuminuria - oxidative stress - diabetes mellitus
Literatur
1
Adler AI, Stevens RJ, Manley SE et al..
Development and progression of nephropathy in type 2 diabetes: the United Kingdom
Prospective Diabetes Study (UKPDS 64).
Kidney Int.
2003;
63
225-232
2
Ritz E, Orth SR.
Nephropathy in patients with type 2 diabetes mellitus.
N Engl J Med.
1999;
341
1127-1133
3
Adler S.
Diabetic nephropathy: Linking histology, cell biology, and genetics.
Kidney Int.
2004;
66
2095-2106
4
Pezzolesi MG, Poznik GD, Mychaleckyj JC et al..
Genome-wide association scan for diabetic nephropathy susceptibility genes in type
1 diabetes.
Diabetes.
2009;
58
1403-1410
5
Hotamisligil GS.
Inflammation and metabolic disorders.
Nature.
2006;
444
860-867
6
Rossing K, Mischak H, Dakna M et al..
Urinary proteomics in diabetes and CKD.
J Am Soc Nephrol.
2008;
19
1283-1290
7
Adler AI, Stratton IM, Neil HA et al..
Association of systolic blood pressure with macrovascular and microvascular complications
of type 2 diabetes (UKPDS 36): prospective observational study.
BMJ.
2000;
321
412-419
8
Parving HH, Andersen AR, Smidt UM, Svendsen PA.
Early aggressive antihypertensive treatment reduces rate of decline in kidney function
in diabetic nephropathy.
Lancet.
1993;
1
1175-1179
9
Holman RR, Paul SK, Bethel MA, Neil HA, Matthews DR.
Long-term follow-up after tight control of blood pressure in type 2 diabetes.
N Engl J Med.
2008;
359
1565-1576
10
Pohl MA, Blumenthal S, Cordonnier DJ et al..
Independent and additive impact of blood pressure control and angiotensin II receptor
blockade on renal outcomes in the irbesartan diabetic nephropathy trial: clinical
implications and limitations.
J Am Soc Nephrol.
2005;
16
3027-3037
11
Parving HH, Persson F, Lewis JB, Lewis EJ, Hollenberg NK.
Aliskiren combined with losartan in type 2 diabetes and nephropathy.
N Engl J Med.
2008;
358
2433-2446
12
The Diabetes Control and Complications Trial Research Group .
The effect of intensive treatment of diabetes on the development and progression of
long-term complications in insulin-dependent diabetes mellitus.
N Engl J Med.
1993;
329
977-986
13
UK Prospective Diabetes Study (UKPDS) Group .
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional
treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Lancet.
1998;
352
837-853
14
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA.
10-year follow-up of intensive glucose control in type 2 diabetes.
N Engl J Med.
2008;
359
1577-1589
15
Nathan DM, Cleary PA, Backlund JY et al..
Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes.
N Engl J Med.
2005;
353
2643-2653
16
Ismail-Beigi F, Craven T, Banerji MA et al..
Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type
2 diabetes: an analysis of the ACCORD randomised trial.
Lancet.
2010;
376
419-430
17
Patel A, MacMahon S, Chalmers J et al..
Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.
N Engl J Med.
2008;
358
2560-2572
18
Duckworth W, Abraira C, Moritz T et al..
Glucose control and vascular complications in veterans with type 2 diabetes.
N Engl J Med.
2009;
360
129-139
19
Pistrosch F, Herbrig K, Kindel B et al..
Rosiglitazone improves glomerular hyperfiltration, renal endothelial dysfunction,
and microalbuminuria of incipient diabetic nephropathy in patients.
Diabetes.
2005;
54
2206-2211
20
Agarwal R.
Vitamin D, proteinuria, diabetic nephropathy, and progression of CKD.
Clin J Am Soc Nephrol.
2009;
4
1523-1528
1 Diabetes Control and Complications Trial
2 United Kingdom Prospective Diabetes Study
3 Action to Control Cardiovascular Risk in Diabetes
4 Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release
Controlled Evaluation
5 Veterans Affairs Diabetes Trial
Korrespondenz
PD Dr. med. Frank Pistrosch
Universitätsklinik „Carl Gustav Carus“ Medizinische Klinik III/Nephrologie
Fetscherstr. 74
01307 Dresden
eMail: Frank.Pistrosch@uniklinikum-dresden.de