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Diabetic Kidney Disease in the Elderly: Diagnosis, Treatment Goals, and Management

机译:老年人糖尿病肾病:诊断,治疗目标和管理

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ABSTRACT: Current guidelines recommend screening patients with diabetes for diabetic kidney disease (DKD) using measurements of kidney damage (albumin-uria) and function (estimated glomerular filtration rate [eGFR]) beginning 5 years after the diagnosis of type 1 diabetes mellitus (DM) or at the time of diagnosis of type 2 DM, and then annually thereafter. Early intervention in patients with chronic kidney disease (CKD)-especially those with DKD-is important, not only to delay the development of end-stage renal disease (ESRD) and the need for renal replacement therapy, but also to decrease mortality. One of the main treatment strategies for DKD is to decrease albuminuria through inhibition of the renin-angiotensin-aldosterone system. The use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers has become the standard of care for the treatment of DKD; however, although these drugs slow progression to ESRD, they are not curative, nor are they necessarily preventive once established diabetic nephropathy is present. Control of other confounding conditions, including blood pressure, lipids, and hyperglycemia, is also important in optimizing patient care.
机译:摘要:目前的指南建议在诊断1型糖尿病(DM)后的5年内,通过测量肾脏损害(白蛋白尿)和功能(估计肾小球滤过率[eGFR])来筛查糖尿病患者的糖尿病肾病)或诊断为2型DM时,此后每年一次。慢性肾脏病(CKD)患者尤其是DKD的早期干预非常重要,不仅要延缓终末期肾脏疾病(ESRD)的发展和对肾脏替代疗法的需求,而且要降低死亡率。 DKD的主要治疗策略之一是通过抑制肾素-血管紧张素-醛固酮系统来降低蛋白尿。血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂的使用已成为治疗DKD的护理标准。然而,尽管这些药物减慢了向ESRD的进展,但它们不能治愈,一旦存在确定的糖尿病性肾病,也不一定具有预防作用。控制其他混杂状况,包括血压,脂质和高血糖症,对优化患者护理也很重要。

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