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中华肾病研究电子杂志 ›› 2021, Vol. 10 ›› Issue (06) : 355 -359. doi: 10.3877/cma.j.issn.2095-3216.2021.06.012

病例报告

糖尿病合并肾病的规范化诊断与治疗2例报告及文献复习
李欢1, 刘开翔1, 冯杰1, 郑在琼1, 谢席胜1,()   
  1. 1. 637001 南充,川北医学院第二临床学院南充市中心医院肾内科
  • 收稿日期:2021-07-26 出版日期:2021-12-28
  • 通信作者: 谢席胜
  • 基金资助:
    四川省卫计委科研项目(19PJ060、18PJ367); 四川省中医管理局(2018JC037); 南充市科技局(YAZX19-Z-04)

Standardized diagnosis and treatment of diabetic kidney disease: a report of two cases and literature review

Huan Li1, Kaixiang Liu1, Jie Feng1   

  • Received:2021-07-26 Published:2021-12-28
引用本文:

李欢, 刘开翔, 冯杰, 郑在琼, 谢席胜. 糖尿病合并肾病的规范化诊断与治疗2例报告及文献复习[J]. 中华肾病研究电子杂志, 2021, 10(06): 355-359.

Huan Li, Kaixiang Liu, Jie Feng. Standardized diagnosis and treatment of diabetic kidney disease: a report of two cases and literature review[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2021, 10(06): 355-359.

图1 患者1肾脏穿刺活检病理结果注:A:HE×400;B:PAS×400,可见肾小球系膜区呈结节状增生、以系膜基质增生为主;C:PASM×400,基底膜弥漫性增厚但钉突样结构不明显;D:Masson×400,基底膜弥漫性增厚,上皮下、内皮下未见嗜复红蛋白沉积;E、F:电镜×3 000,送检标本未见肾小球
图2 患者2肾脏穿刺活检病理结果注:A:PAS×400,肾小球系膜细胞和基质轻度增生、毛细血管襻开放;B:PASM×400,肾小球基底膜增厚、可见钉突样结构;C:Masson×400,肾小球基底膜增厚、上皮下可见嗜复红蛋白沉积
表1 2014年日本DKD联合委员会关于DKD分期[18]
表2 肾脏病理学会研究委员会发布的病理分级标准诊断DN病理分型(小球病变)[19]
表3 肾脏病理学会研究委员会发布的病理分级标准DN病理分型(小管肾间质及血管评分标准)[19]
[1]
International Diabetes Federation. IDF diabetes atlas [DB/OL]. 2019:

URL    
[2]
Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045 [J]. Diabetes Res Clin Pract, 2018, 138: 271-281
[3]
中华医学会糖尿病学分会微血管并发症学组. 中国糖尿病肾脏疾病防治临床指南[J]. 中华糖尿病杂志2019, 11(1): 15-28.
[4]
Zhang L, Long J, Jiang W, et al. Trends in chronic kidney disease in China [J]. N Engl J Med, 2016, 375(9): 905-906.
[5]
Mottl AK, Gasim A, Schober FP, et al. Segmental sclerosis and extracapillary hypercellularity predict diabetic ESRD [J]. J Am Soc Nephrol, 2018, 29(2): 694-703.
[6]
Scheen AJ. Effects of glucose-lowering agents on surrogate endpoints and hard clinical renal outcomes in patients with type 2 diabetes [J]. Diabetes Metab, 2019, 45(2): 110-121.
[7]
田冬琴,刘开翔,占志朋,等. 糖尿病肾病规范化诊断研究进展[J/CD].中华肾病研究电子杂志2019, 8(3): 132-137.
[8]
Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD [J]. Eur Heart J, 2020, 41(2): 255-323.
[9]
田冬琴,卢丹,刘开翔,等. 糖尿病肾脏疾病诊治进展[J]. 实用糖尿病杂志2018, 14(3): 70-72.
[10]
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease [J]. Kidney Int Suppl, 2013, 3(1): 1-150.
[11]
Anders HJ, Huber TB, Isermann B, et al. CKD in diabetes: diabetic kidney disease versus nondiabetic kidney disease [J]. Nat Rev Nephrol, 2018, 14(6): 361-377.
[12]
Jiang S, Wang Y, Zhang Z, et al. Accuracy of hematuria for predicting non-diabetic renal disease in patients with diabetes and kidney disease: a systematic review and meta-analysis [J]. Diabetes Res Clin Prac, 2018, 143: 288-300.
[13]
Tuttle KR, Bakris GL, Bilous RW, et al. Diabetic kidney disease: a report from an ADA consensus conference [J]. Diabetes Care, 2014, 37(10): 2864-2883.
[14]
American Diabetes Association. Standards of medical care in diabetes-2016: summary of revisions [J]. Diabetes Care, 2016, 39(Suppl 1): S4-S5.
[15]
National Kidney Foundation. KDOQI clinical practice guideline for diabetes and CKD: 2012 update [J]. Am J Kidney Dis, 2012, 60(5): 850-886.
[16]
Liang S, Zhang XG, Cai GY, et al. Identifying parameters to distinguish non-diabetic renal diseases from diabetic nephropathy in patients with type 2 diabetes mellitus: a meta-analysis [J]. PLoS One, 2013, 8(5): e64184.
[17]
Wang J, Han Q, Zhao L, et al. Identification of clinical predictors of diabetic nephropathy and non-diabetic renal disease in Chinese patients with type 2 diabetes, with reference to disease course and outcome [J]. Acta Diabetol, 2019, 56(8): 939-946.
[18]
Haneda M, Utsunomiya K, Koya D, et al. A new classification of diabetic nephropathy 2014: a report from joint committee on diabetic nephropathy [J]. J Diabetes Investig, 2015, 6(2): 242-246.
[19]
Tervaert TW, Mooyaart AL, Amann K, et al. Pathologic classification of diabetic nephropathy [J]. J Am Soc Nephrol, 2010, 21(4): 556-563.
[20]
González-Pérez A, Saéz ME, Vizcaya D, et al. Impact of chronic kidney disease definition on assessment of its incidence and risk factors in patients with newly diagnosed type 1 and type 2 diabetes in the UK: a cohort study using primary care data from the United Kingdom [J]. Prim Care Diabetes, 2020, 14(4): 381-387.
[21]
中华医学会,中华医学会杂志社,中华医学会全科医学分会,等. 成人社区获得性肺炎基层诊疗指南(2018年)[J]. 中华全科医师杂志2019, 18(2): 117-126.
[22]
Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults [J]. Clin Infect Dis, 2007, 44(Suppl 2): S27-S72.
[23]
Montaigne D, Marechal X, Coisne A, et al. Myocardial contractile dysfunction is associated with impaired mitochondrial function and dynamics in type 2 diabetic but not in obese patients [J]. Circulation, 2014, 130(7): 554-564.
[24]
Chiang CE, Lin SY, Lin TH, et al. 2018 consensus of the Taiwan Society of Cardiology and the Diabetes Association of Republic of China (Taiwan) on the pharmacological management of patients with type 2 diabetes and cardiovascular diseases [J]. J Chin Med Assoc, 2018, 81(3): 189-222.
[25]
Molitch ME, Adler AI, Flyvbjerg A, et al. Diabetic kidney disease: a clinical update from Kidney Disease: Improving Global Outcomes [J]. Kidney Int, 2015, 87(1): 20-30.
[26]
中华医学会糖尿病学分会,中华医学会内分泌学分会. 中国成人2型糖尿病合并心肾疾病患者降糖药物临床应用专家共识[J]. 中华内分泌代谢杂志2020, 36(6): 458-468.
[27]
American Diabetes Association. 3. Prevention or delay of type 2 diabetes: standards of medical care in diabetes-2020 [J]. Diabetes Care, 2020, 43(Suppl 1): S32-S36.
[28]
American Diabetes Association. Addendum. 10. Cardiovascular disease and risk management: standards of medical care in diabetes-2020. Diabetes Care 2020;43(Suppl 1): S111-S134 [J]. Diabetes Care, 2020, 43(8): 1977-1978.
[29]
Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy [J]. N Engl J Med, 2019, 380(24): 2295-2306.
[30]
Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in patients with chronic kidney disease [J]. N Engl J Med, 2020, 383(15): 1436-1446.
[31]
Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes [J]. N Engl J Med, 2016, 375(4): 311-322.
[32]
Rosenstock J, Perkovic V, Johansen OE, et al. Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk: the CARMELINA randomized clinical trial [J]. JAMA, 2019, 21(1): 69-79.
[33]
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2020 [J]. Diabetes Care, 2020, 43(Suppl 1): S14-S31.
[34]
American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes-2021 [J]. Diabetes Care, 2021, 44(Suppl 1): S111-S124.
[35]
International Society of Nephrology. Chapter 7: idiopathic membranous nephropathy [J]. Kidney Int Suppl, 2012, 2(2): 186-197.
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