Nefropati pada pasien diabetes mellitus
Diabetes is responsible for 30–40% of all end-stage renal disease (ESRD) cases in the United States. Diabetic nephropathy is the leading cause of chronic renal failure in United States and other Western societies. Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria (>300 mg/d or >200 mcg/min) that is confirmed on at least 2 occasions 3–6 months apart, a relentless decline in the glomerular filtration rate (GFR), and elevated arterial blood pressure. Risk factors for development of diabetic nephropathy include hyperglycemia, hypertension, positive family history of nephropathy and hypertension, and smoking. The pathophysiologic mechanisms of diabetic nephropathy are incompletely understood but include glycosylation of circulating and intrarenal proteins, hypertension, and abnormal intrarenal hemodynamics. The earliest demonstrable abnormalities include intrarenal hypertension, hyperfiltration (increased glomerular filtration rate [GFR]), and microalbuminuria. Clinically, the most important screening tool for identifying early nephropathy is detection of microalbuminuria. Screening for diabetic nephropathy involves monitoring at least yearly for urinary albumin excretion >30 mg per day. Key elements in the primary care of diabetes include glycemic control, blood pressure control, and proteinuria control. Prevention of diabetic nephropathy should be done before overt nephropathy.
diabetic nephropathy, microalbuminuria, prevention
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Damianus Journal of Medicine
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