华西课件糖尿病慢性肾脏疾病课件.ppt

尿蛋白 In most patients with diabetes, CKD should be attributable to diabetes if: ● 存在大量白蛋白尿(B) ● 存在微量白蛋白尿 _伴糖尿病视网膜病变 (B) _ 1型糖尿病10年病程以上 (A) Other cause(s) of CKD (B) GFR迅速降低 予ACEI或ARB后在2-3月内GFR减少30% 顽固性 高血压 迅速增加的蛋白尿或肾病综合征 其他系统性疾病的症状或体征 缺乏糖尿病视网膜病变 根据GFR分期和白蛋白尿水平确定DKD Albuminuria GFR (mL/min) CKD Stage* Normoalbuminuria Microalbuminuria Macroalbuminuria 60 1 + 2 At risk? Possible DKD DKD 30-60 3 Unlikely DKD Possible DKD DKD 30 4+5 Unlikely DKD Unlikely DKD DKD 防治及展望 GUIDELINE 2Management of Hyperglycemia and General Diabetes Care in CKD 无论是否存在CKD，糖尿病患者糖化血红蛋白（HbA1c）的靶目标值是 7.0% (A) ● Lowering HbA1c levels to approximately 7.0% reduces the development of microalbuminuria (Strong) % relative risk reduction P=0.03 P0.01 P0.01 P=0.05 P=0.02 UKPDS Group. Lancet. 1998;352:837-853. UKPDS 强化血糖控制与常规控制相比减少并发症的相对危险 Over 10 years, HbA1c was 7.0% (6.2-8.2) in the intensive group (n=2,729) compared with 7.9% (6.9-8.8) in the conventional group (n=1,138). EDIC强化血糖控制与常规控制相比减少并发症的相对危险 Prevalence incidence of microalbuminuria at the end of the DCCT and during the EDIC Study Differences between the 2 treatment groups are significant (P0.001) JAMA 2003,290:2159-67 DKD患者伴高血压的流行病学 Clinical Features Prevalence(%) Type 1 diabetes microalbuminuria 30-50 Type 1 diabetes macroalbuminuria 65-88 Type 2 diabetes microalbuminuria 40-83 Type 2 diabetes macroalbuminuria 78-96 Am J Kidney Dis, 2007,49(supp2): S1-S178 Guideline 3Management of Hypertension in Diabetes and CKD CKD1-4期糖尿病伴高血压患者应该用ACEI或ARB治疗，常与利尿剂合用 (A) CKD1-4期糖尿病患者目标血压应 130/80 mmHg (B) ACEI在延缓1型糖尿病伴高血压以大量白蛋白尿为标志的肾脏疾病进展时比其他降