糖尿病肾病变DiabeticNephropathy.PPT

糖尿病腎病變Diabetic Nephropathy 蔡宜潔醫師 Feb. 24, 2008 Outline Introduction of diabetic nephropathy Manifestations of diabetic nephropathy Staging of diabetic nephropathy Microalbuminuria Diagnosis of diabetic nephropathy Treatment of diabetic nephropathy The leading cause of end-stage renal disease Diabetic nephropathy- → 30~40% type 1 DM vs. 20% type 2 DM after years Majority of diabetic p’ts with ESRD→Type 2 DM Prevalence of type 2 DM type 1DM (10~15x) Susceptibility to DMN Ethnicity- South Asian, African Caucasian Gender- ♂♀(1.7:1) Age of DM onset (11~20 y/o in type 1 DM p’t) Cf. 50y/o in type 2 DM p’t: incidence↑ Natural history of DM nephropathy →Better defined in type 1 DM →5 stages Clinical and morphologic features →Similar in type 1 DM and type 2 DM Glomerular hypertension and hyperfiltration are the earliest renal abnormalities Course of GFR change: more variable in type 2 DM → GFR decline: 5~10cc/min/year (1~20 cc/min/year in type 2 DM) DM nephropathy stages Stage 1:hyperfiltration phase Stage 2:silent phase Stage 3:microalbuminuria phase Stage 4:macroalbuminuria phase Stage 5:ESRD Describes the renal hypertrophy and hyperfiltration that present at the time of diagnosis of type 1 DM . GFR and UAER- elevated by 20-40% (UAER: urine albumin excretion rate) → GFR and UAER↓while insulin therapy Clinically silent (GFR↑) Early histologic change (GBM/Matrix ↑) Hyperfiltration related to Degree of hyperglycemia (up to 250 mg/dL), higher levels of glycemia- GFR↓ Better glucose control- hyperfiltration↓ Typically lasts for 5-15 years Incipient nephropathy Occurs after 6 -15 years of diabetes UAER: 30-300mg/d Always small but detectable BP↑ Impairment of nocturnal BP “dipping” GFR is elevated or reduced into normal range Initial hyperfiltration ? greater subsequent rate of decline in GFR 24Hr BP Profile in Hypertension (Dipper vs non-dipper) Established or overt nephropahty Characteristics Clear histologic changes HTN- established in most patients Prote