Diyabetin Kronik Böbrek Hastalığını Gelişmesi ve Tedavisine Etkisi

Yıl 2011, Cilt: 08 Sayı: 1, 11 - 17, 30.06.2011

Feray Gökdo⁄an

Öz

Diyabetes mellitus, diyaliz ya da transplantasyon gerektiren

son dönem böbrek hastal›¤›n›n bafll›ca nedenini ve yeni

vakalar›n %44’ünü oluflturmaktad›r. Diyabetli say›s›ndaki

art›fl ve toplumun yafllanmas›yla birlikte Son Dönem

Böbrek Hastal›¤› vakalar›n›n say›s› da artmaya devam etmektedir.

Diyabetik nefropati; proteinüri, hipertansiyon ve

ilerleyici böbrek yetmezli¤inin birlikte görüldü¤ü klinik bir

sendromdur. Diyabetik nefropatinin belirleyicileri olarak ailesel

ve genetik faktörler, diyabetin süresi, hiperglisemi,

proteinüri, hipertansiyon, hiperlipidemi, diyet ve sigara içme

büyük öneme sahip faktörlerdir. Bu makalede diyabetlilerde

s›k› bir metabolik kontrol ile sistemik ve glomerul hipertansiyonun

kontrolü, diyette protein k›s›tlamas›yla böbrek

fonksiyonlar›n›n korunup, diyabetik nefropatinin gelifliminin

geciktirilebilece¤i üzerinde durulmaktad›r.

Anahtar Kelimeler

Diyabetik nefropati, Proteinüri, Korunma

Kaynakça

• 1. National High Blood Pressure Education Program: National High Blood Pressure Education Program working group report on hypertension and chronic renal failure. Arch Intern Med 1991; 151:1280-1287.
• 2. Nelson RG. Diabetic renal disease in transitional and disadvantaged populations. Nephrology 2001; 6 (1): 9–17.
• 3. Ritz E .Nephropathy in type 2 diabetes. Journal of Internal Medicine. 1999; 245 (2): 111–126.
• 4. CDC. Incidence of End-Stage Renal Disease Among Persons With Diabetes: United States, 1990—2002. November 4, 2005; 54(43); 1097-1100.
• 5. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27:1047-53.
• 6. Barsoum, Rashad S. Chronic kidney disease in the developing world. New England Journal of Medicine. 2006;(354): 10.
• 7. King H, Aubert RE, HermanWH. Global burden of diabetes, 1995–2025. Prevalence, numerical estimates, and projections. Diabetes Care 1998; 21: 1414-1431.
• 8. Lok C, Oliver MJ, Rothwell DM, et al. The growing volume of diabetes-related dialysis: a population based study. Nephrology Dialysis Transplantation 2004; 19(12):3098-3103.
• 9. Andersen AR, Christiansen JS, Andersen JK, et al. Diabetic nephropathy in type I (insulin-dependent) diabetes: an epidemiological study. Diabetologia 1983; 25:496-501).
• 10. Levey AS. Assessing the effectiveness of therapy to prevent the progression of renal disease. Am J Kidney Dis 1993; 22:207-214.
• 11. Levey AS, Gassman JJ, Hall PM, et al (for the Modification of Diet in Renal Disease (MDRD) Study Group: Assessing the progression of renal disease in clinical studies: effects of duration of follow-up and regression to the mean. J Am Soc Nephrol. 1991; 1:1087-1094.
• 12. Fabre J, Balant LP, Dayer PG, et al. The kidney in maturity onset diabetes mellitus: a clinical study of 510 patients. Kidney Intern. 1982; 21: 730-738.
• 13. Palumbo PJ, Elveback ER, Chu CP, et al. Diabetes mellitus: incidence, prevalence, survivorship, and causes of death in Rochester, Minnesota, 1945–1970. Diabetes 1976; 25: 566-573.
• 14. Biesenbach G, Janko O, Zazgornik J. Similar rate of progression in the predialysis phase in type 1 and type 2 diabetes mellitus. Nephrol Dial Transplant 1994; 9: 1097-1102.
• 15. Ritz E & Stefanski A. Diabetic nephropathy in type 2 diabetes. Am J Kidney Dis 1996; 27: 167-194.
• 16. Gall MA, Hougaard P, Borch-Johnsen K, et al. Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: pros pective, observational study. Br Med J 1997; 314: 783 8.
• 17. Seaquist ER, Gotz FC, Rich S, et al. Familial clustering of diabetic kidney disease. Evidence for genetic susceptibility to diabetic nephropathy. N Engl J Med 1989; 320: 1161-1165.
• 18. Haffner SM, Gonzales C, Valdez RA, et al. Is microalbuminuria part of the prediabetic state? The Mexico City Diabetes Study. Diabetologia 1993; 36: 1002-1006.
• 19. Mogensen CE. Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 1987; 31:673-689.
• 20. Ballard DJ, Humphrey LL, Melton LJ, et al. Epidemiology of persistent proteinuria in type 2 diabetes melllitus. Population based study in Rochester, Minnesota. Diabetes 1988; 37: 405-412.
• 21. Ohkubo Y, Kishikawa H, Araki E. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6 year study. Diabetes Res 1995; 28: 103-117.
• 22. Niskanen L, Laakso M. Insulin resistance is related to albuminuria in patients with type 2 diabetes mellitus. Metabolism 1993; 42: 1541-1545.
• 23. Mykkanen L, Haffner SM, Kuusisto J, et al. Microalbuminuria precedes the development of NIDDM. Diabetes 1994; 43: 552-557.
• 24. Viberti GC, Hill RD, Jarrett RJ, et al. Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet 1982; 1:1430-1432.
• 25. Consensus Statement: Preventing the kidney disease of diabetes mellitus: public health perspectives. Proceedings from the International Workshop on Preventing the Kidney Disease of Diabetes Mellitus: Public Health Perspectives. Hawthorne VM, Herman WH (eds). Am J Kidney Dis 1989; 13:2-6.
• 26. Delcourt C, Vauzelle-Kervroedan F, Cathelineau G, et al. Low prevalence of long-term complications in non-insulin-dependent diabetes mellitus in France: a multicenter study. CODIABINSERM- ZENECA Pharma Study Group. J Diabet Complications 1998; 12:88-95.
• 27. Outcomes Prevention Evaluation Study Investigators. Effects of Ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus. Results of the HOPE study and MICRO-HO PE substudy. Lancet 2000; 355:253-259.
• 28. Krolewski AS, Warram JH, Christlieb AR, et al. The changing natural history of nephropathy in type I diabetes. Am J Med 1985; 78: 785-794.
• 29. Guyton AC. Formation of urine by the kidney: glomerular filtration, tubular function, and plasma clearance. Textbook of Medical Physiology. Guyton AC (ed). Philadelphia, WB Saunders Co, 7th Ed, 1986, p 393.
• 30. Hostetter TH, Troy JL, Brenner BM. Glomerular hemodynamics in experimental diabetes mellitus. Kidney Int 1981; 19: 410-415.
• 31. Zatz R, Meyer TW, Rennke HG, et al. Predominance of hemodynamic rather than metabolic factors in the pathogenesis of diabetic glomerulopathy. Proc Natl Acad Sci USA 1985; 82: 5963- 5596.
• 32. Hostetter TH, Rennke HG, Brenner BM. The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies. Am J Med 1982; 72:375-380.
• 33. Remuzzi G, Bertani T. Is glomerulosclerosis a consequence of altered glomerular permeability to macromolecules? Kidney Int. 1990; 38: 384-394.
• 34. Brenner BM, Meyer TW, Hostetter TH. Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med 1982; 307:652-659.
• 35. Textor SC: Renal hemodynamics in hypertension. Am J Kidney Dis 1987; 10:24-49.
• 36. Hall JE, Coleman TG, Guyton AC, et al. Control of glomerular filtration rate by circulating angiotensin II. Am J Physiol 1981; 241:R190-R197.
• 37. Mogensen CE. Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 1987; 31:673-689;
• 38. Weldmann P. Pathogenesis and treatment of hypertension associated with diabetes mellitus. Am Heart J 1993; 125:1498-1513.
• 39. Ritz E. Hypertension in diabetic nephropathy: prevention and treatment Am Heart J 1993; 125:1514-1519.
• 40. Stern MP. Diabetes and cardiovascular disease. The ‘common soil’ hypothesis. Diabetes 1995; 44:369-374.
• 41. Orth S, Ritz E, Schrier R. The renal risk of smoking. Kidney Int 1997; 51: 1669-1677.
• 42. Keller CK, Bergis KG, Flkiser D, et al. Renal findings in patients with short term type 2 diabetes. JASN 1996; 7: 2627-2635.
• 43. Olivarus NF, Andreasen AH, Keiding N, et al. Epidemiology of renal involvement in newly diagnosed middle-aged and elderly diabetic patients. Cross-sectional data from the population-based study ‘Diabetes Care in General Practice’. Denmark Diabetologia 1993; 36: 1007-1016.
• 44. Neuringer JR, Brenner BM. Hemodynamic theory of progressive renal disease: a 10-year update in brief review. Am J Kidney Dis 1993; 22:98-104.
• 45. Bauer JH. Diabetic nephropathy: Can it be prevented? Are there renal protective antihypertensive drugs. Southern Medical Journal, 1994, Vol. 87, Issue 10: 1043-1053.
• 46. Tobe SW, McFarlane PA, Naimark DM. Microalbuminuria in diabetes mellitus.Canadian Medical Association Journal, 2002, Vol. 167, Issue 5
• 47. Krolewski AS, Laffel LM, Krolewski M, et al. Glycosylated hemoglobin and the risk of microalbuminuria in patients with insulin-dependent diabetes mellitus. N Engl J Med 1995; 332:1251- 1255.
• 48. Microalbuminuria Collaborative Study Group. Predictors of the development of microalbuminuria in patients with type 1 diabetes mellitus: a seven-year prospective study. Diabet Med 1999;16:918- 925.
• 49. Tuttle KR, Bruton JL, Perusek MC, et al. Effect of strict glycemic control on renal hemodynamic response to amino acids and renal enlargement in insulin-dependent diabetes mellitus. N Engl J Med 1991; 324:1626-1632.
• 50. 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.
• 51. Wang PH, Lau J, Chalmers TC. Meta-analysis of effects of intensive blood-glucose control on late complications of type I diabetes. Lancet 1993; 341:1306-1309.
• 52. Marre M, Leblanc H, Suarez L, et al. Converting enzyme inhibition and kidney function in normotensive diabetic patients with persistent microalbuminuria. BMJ 1987; 294:1448-1452.
• 53. Bretzel RG, Bollen CC, Maeser E, et al. Nephroprotective effects of nitrendipine in hypertensive type I and type II diabetic patients. Am J Kidney Dis 1993; 21:53-64.
• 54. McAlister FA, Levine M, Zarnke KB, et al. The 2000 Canadian recommendations for the management of hypertension: Part one — therapy. Can J Cardiol 2001;17:543-559.
• 55. Fodor JG, Frohlich JJ, Genest JJG et al. The Working Group on Hypercholesterolemia and Other Dyslipidemias. Recommendations for the management and treatment of dyslipidema. CMAJ 2000;162(10):1441-1447.
• 56. Gransevoort RT, de Zeeuw D, de Jong PE. Dissociation between the course of the hemodynamic and antiprotein-uric effects of angiotensin I converting enzyme inhibitor. Kidney Int 1993; 44: 579-584.
• 57. Bauer JH, Reams GP: Renal protection in essential hypertension: how do angiotensin converting enzyme inhibitors compare with calcium antagonists? J Am Soc Nephrol 1990; 1:580-587.
• 58. Rudberg S, Darlquist G, Aperia A, et al. Reduction of protein intake decreases glomerular filtration rate in young type I (insulindependent) diabetic patients mainly in hyperfiltering patients. Diabetologia 1988; 31:878-883.
• 59. Zeller K, Whittaker E, Sullivan L, et al. Effect of restricting dietary protein on the progression of renal failure in patients with insulindependent diabetes mellitus. N Engl J Med 1991; 324:78-84.