Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management

[摘要] It is an irony of medical progress that the renal involvement in diabetes mellitus type 2 had been considered twenty years ago (1) as a benign condition for the kidney without causing renal function loss greater than expected from the “normal” aging process. In contrast, today it has become the single most common cause of end-stage renal disease (ESRD) in the entire Western world (2–4⇓⇓). Apart from the individual human suffering that cannot be expressed in numbers, patients with type 2 diabetes undergoing maintenance dialysis consume significantly more financial resources than those with nondiabetic ESRD. In addition, type 2 diabetic patients do poorly on dialysis and have an excess mortality (5). An interdisciplinary approach is needed for patients with type 2 diabetes and nephrologists must deal with a spectrum of comorbidity besides diabetic nephropathy. The famous Dr. Elliot P. Joslin (1869–1962) stated: “With a missionary zeal, one must convert not only the patient’s mind and soul, but also his doctor to the realization that it is worth the effort to control the disease as shown by the sugar-free urine, normal blood sugar and cholesterol” (6). We posit that a similar approach is also indicated with respect to prevention and treatment of nephropathy in patients with type 2 diabetes mellitus.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome