Dijabetesna nefropatija: klinička prezentacija i savremene mogućnosti lečenja

Višnja D Ležaić

doi:10.5937/opmed29-36873

Višnja D Ležaić Belgrade University, Medical School

DOI: https://doi.org/10.5937/opmed29-36873

Ključne reči: dijabetesna bolest bubrega, KDIGO vodič, fenotipske varijacije, lečenje

Sažetak

Dijabetesna bolest bubrega (DBB) je jedna od glavnih komplikacija dijabetesa (DM) i vodeći uzrok hronične bolesti bubrega (HBB) širom sveta. Oko 10% bolesnika sa DBB napreduje u terminalnu HBB, а ostali umiru najčešće zbog kardiovaskularnih pormećaja i infekcije i pre nego što im je potrebno lečenje zamene rada bubrega. Glavne strategije za sprečavanje razvoja i ublažavanje progresije DBB u poslednjim decenijama bile su intenzivna kontrola glikemije i blokada renin-angiotenzin-aldosteronskog sistema. Međutim, ovaj pristup nije postigao optimalne rezultate. Uzimajući u obzir porast bolesnika sa DBB, visoku potrošnju iz budžeta zdravstvene zaštite i razoj novih terapijskih mogućnosti sa značajnom zaštitom bubrega, Međunarodno društvo za nefrologiju izdalo je tokom 2020. godine. (od engl naziva Kidney Disease: Improving Global Outcomes (KDIGO) Guideline) prvi vodič za lečenje bolesnika sa DBB. Ovaj revijalni rad ima za cilj da ukaže na fenotipsku varijabilnost i prikaže nedavna dostignuća u lečenju DBB.

Biografija autora

Višnja D Ležaić, Belgrade University, Medical School

nephrology, kidney transplantation,

Reference

GBD Chronic Kidney Disease

Collaboration. Global, regional, and

national burden of chronic kidney disease,

–2017: a systematic analysis for the

Global Burden of Disease Study 2017.

Lancet 2020;395(10225):709–33.

Ortiz A, Covic A, Fliser D, Fouque

D , Goldsmith D , Kanbay M, et al. Epidemiology,

contributors to, and clinical trials of

mortality risk in chronic kidney failure.

Lancet 2014;383(9931):1831–43.

GBD 2015 Mortality and Causes of

Death Collaborators. Global, regional,

and national life expectancy, all-cause

mortality, and cause-specific mortality

for 249 causes of death, 1980–2015: a

systematic analysis for the Global Burden

of Disease Study 2015. Lancet 2016;

(10053):1459–544.

Levin A, Tonelli M, Bonventre J, Coresh

J , Donner JA , Fogo AB, et al. Global kidney health

and beyond: a roadmap for closing

gaps in care, research, and policy. Lancet

;390(10105):1888–917.

Jha V, Garcia-Garcia G, Iseki K, Li

Z, Naicker S, Plattner B, et al. Chronic

kidney disease: global dimension and

perspectives. Lancet 2013;382(9888):

–72.

International Diabetes Federation:

Diabetes Atlas, 7th ed. Brussels, Belgium.

IDF Executive Office; 2015.

Zoccali C, Vanholder R, Massy ZA, Ortiz

A, Sarafidis P, Dekker FW, et al. The

systemic nature of CKD. Nat Rev Nephrol

;13(6):344–58.

Kidney Disease: Improving Global

Outcomes Diabetes Work Group. KDIGO

clinical practice guideline for

diabetes management in chronic kidney

disease. Kidney Int 2020; 98(4S):S1–

S115.

Zhang L, Long J, Jiang W, Shi Y, He

X, Zhou Z, et al. Trends in Chronic

Kidney Disease in China. N Engl J Med

;375(9):905–6.

Godišnji izveštaj o lečenju dijalizama i

transplantacijom bubrega u Srbiji, 2016.

Beograd: Udruženje nefrologa Srbije;

Alicic RZ, Rooney MT, Tuttle KR.

Diabetic kidney disease: challenges,

progress, and possibilities. Clin J Am Soc

Nephrol 2017;12(12):2032–45.

Antić M, Jotić A, Radović M, Seferović

JP, Lalić NM, Jovanović D, et al. [Risk

factors for the development of diabetic

nephropathy]. Srp Arh Celok Lek

;137(1-2):18–26.

Afkarian M, Zelnick LR, Hall YN,

Heagerty PJ, Tuttle K, Weiss NS, et al.

Clinical manifestations of kidney disease

among US adults with diabetes, 1988–

JAMA 2016;316(6):602–10.

Parving HH, Persson F, Rossing P.

Microalbuminuria: a parameter that has

changed diabetes care. Diabetes Res Clin

Pract 2015;107(1):1–8.

Levey AS, de Jong PE, Coresh J, El Nahas

M, Astor BC, Matsushita K, et al. The

definition, classification, and prognosis

of chronic kidney disease: a KDIGO

Controversies Conference report. Kidney

Int 2011;80(1):17–28.

Oshima M, Shimizu M, Yamanouchi

M, Toyama T, Hara A, Furuichi K, et al.

Trajectories of kidney function in diabetes:

a clinicopathological update. Nat Rev

Nephrol 2021;17(11):740–50.

Dwyer JP, Lewis JB. Nonproteinuric

diabetic nephropathy: when diabetics

don’t read the textbook. Med Clin N Am

;97(1):53–8.

Krolewski AS. Progressive renal decline:

the new paradigm of diabetic nephropathy

in type 1 diabetes. Diabetes Care

;38(6):954–62.

American Diabetes Association. 10.

Microvascular Complications and

Foot Care: Standards of Medical Care

in Diabetes – 2018. Diabetes Care

;41(Suppl 1):S105–S118.

Taal MW: Risk factors and chronic kidney

disease. In: Brenner and Rector’s The

Kidney, 10th Ed., edited by Skorecki K,

Amsterdam, Elsevier, 2015, 669–692.e7

Montero RM, Covic A, Gnudi L,

Goldsmith D. Diabetic nephropathy: what

does the future hold? Int Urol Nephrol

;48(1):99–113.

UK Prospective Diabetes Study Group.

Tight blood pressure control and risk

of macrovascular and microvascular

complications in type 2 diabetes: UKPDS

UK Prospective Diabetes Study Group.

BMJ 1998;317(7160):703–13.

Jensen T, Borch-Johnsen K, Deckert

T. Changes in blood pressure and renal

function in patients with type I (insulindependent)

diabetes mellitus prior to

clinical diabetic nephropathy. Diabetes

Res 1987;4(4):159–62.

Parving HH. Controlling hypertension in

diabetes. Acta Diabetol 2002;39(Suppl

:S35–40.

Stratton IM, Cull CA, Adler AI, Matthews

DR, Neil HA, Holman RR. Additive

effects of glycaemia and blood pressure

exposure on risk of complications in type

diabetes: a prospective observational

study (UKPDS 75). Diabetologia

;49(8):1761–9.

Djukanović L, Lezaić V, Dimković

N, Peruničić Peković G, Bukvić

D, Bajčetić S, et al. Early detection of

chronic kidney disease: collaboration of

Belgrade nephrologists and primary care

physicians. Nefrologia 2012;32(1):59–66.

Strippoli GFM, Bonifati C, Craig M,

Navaneethan SD, Craig JC. Angiotensin

converting enzyme inhibitors and

angiotensin II receptor antagonists for

preventing the progression of diabetic

kidney disease. Cochrane Database Syst

Rev 2006;2006(4):CD006257.

The Diabetes Control and Complications

(DCCT) Research Group. Effect of

intensive therapy on the development and

progression of diabetic nephropathy in the

diabetes control and complications trial.

Kidney Int 1995;47(6):1703–20.

Nathan DM, DCCT/EDIC Research

Group. The diabetes control and

complications trial/epidemiology of

diabetes interventions and complications

study at 30 years: Overview. Diabetes

Care 2014;37(1):9–16.

DCCT/EDIC Research Group; de Boer

IH, Sun W, Cleary PA, Lachin JM,

Molitch ME, Steffes MW, et al. Intensive

diabetes therapy and glomerular filtration

rate in type 1 diabetes. N Engl J Med

;365(25):2366–76.

Holman RR, Paul SK, Bethel MA,

Matthews DR, Neil HAW. 10- year

follow-up of intensive glucose control

in type 2 diabetes. N Engl J Med

;359(15):1577–89.

Parving HH, Lehnert H, Bröchner-

Mortensen J, Gomis R, Andersen S, Arner

P, et al. The effect of irbesartan on the

development of diabetic nephropathy in

patients with type 2 diabetes. N Engl J

Med 2001;345(12):870–8.

Brenner BM, Cooper ME, de Zeeuw

D, Keane WF, Mitch WE, Parving HH,

et al. Effects of losartan on renal and

cardiovascular outcomes in patients with

type 2 diabetes and nephropathy. N Engl J

Med 2001;345(12):861–9.

Banerjee D , Winocour P , Chowdhury

TA, De P, Wahba M, Monteroet R, et al.

Management of Hypertension in Patients

With Diabetic Kidney Disease: Summary

of the Joint Association of British

Clinical Diabetologists and UK Kidney

Association Guideline 2021. Kidney Int

Rep 2022;7(4):681–7.

Little RR, Rohlfing CL, Tennill AL,

Hanson SE, Connolly S, Higgins T, et al.

Measurement of Hba(1C) in patients with

chronic renal failure. CLIN CHIM ACTA

;418:73–6.

Zelnick LR, Batacchi ZO, Ahmad I, Dighe

A, Little RR, Trence DL, et al. Continuous

Glucose Monitoring and Use of

Alternative Markers To Assess Glycemia

in Chronic Kidney Disease. Diabetes Care

;43(10):2379–87.

Battelino T, Danne T, Bergenstal RM,

Amiel SA, Beck R, Biesteret T, et

al. Clinical Targets for Continuous

Glucose Monitoring Data Interpretation:

Recommendations From the International

Consensus on Time in Range. Diabetes

Care 2019;42(8):1593–603.

Neuen BL, Young T, Heerspink HJL,

Neal B, Perkovic V, Billot L, et al.

SGLT2 inhibitors for the prevention of

kidney failure in patients with type 2

diabetes: a systematic review and metaanalysis.

Lancet Diabetes Endocrinol

;7(11):845–54.

Wanner C, Inzucchi SE, Lachin JM,

Fitchett D, von Eynatten M, Mattheus

M, et al. EMPA-REG OUTCOME

Investigators . Empagliflozin and

Progression of Kidney Disease in Type 2

Diabetes. N Engl J Med 2016;375(4):323–

Perkovic V, Jardine MJ, Neal B, Bompoint

S, Heerspink HJL, Charytan DM, et al.

Canagliflozin and renal outcomes in type

diabetes and nephropathy. New Engl J

Med 2019;380(24):2295–306.

Highlights of prescribing information.

Invokana (canagliflozin) tablets. http://

www.janssenlabels.com/package-insert/

product-monograph/prescribinginformation/

INVOKANA-pi.pdf

Alicic RZ, Cox EJ, Neumiller JJ, Tuttle

KR. Incretin drugs in diabetic kidney

disease: biological mechanisms and

clinical evidence. Nat Rev Nephrol

;17(4):227–44.

Shavit L, Lifschitz MD, Epstein

M. Aldosterone blockade and the

mineralocorticoid receptor in the

management of chronic kidney disease

current concepts and emerging treatment

paradigms. Kidney Int 2012;81(10):

–68.

Alexandrou ME, Papagianni A, Tsapas

A, Loutradis C, Boutou A, Piperidou A, et

al. Effects of mineralocorticoid receptor

antagonists in proteinuric kidney disease:

A systematic review and meta-analysis of

randomized controlled trials. J Hypertens

;37(12):2307–24.

Agarwal R, Filippatos G, Pitt B,

Anker SD, Rossing P, Joseph A, et al.

Cardiovascular and kidney outcomes

with finerenone in patients with type 2

diabetes and chronic kidney disease: the

FIDELITY pooled analysis. Eur Heart J

;43(6):474–84.