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당뇨병성 신증의 최신 지견

Recent Update in Diabetic Nephropathy

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대한내과학회 (The Korean Association Of Internal Medicine)|2015.09|대한내과학회지 (The Korean Journal of Medicine)|제89권 제3호|pp. 265-270|DOI http://dx.doi.org/10.3904/kjm.2015.89.3.265

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키워드

Chronic진단치료DiagnosisRenal insufficiencyAlbuminuriaTherapeuticsDiabetic nephropathies알부민뇨만성신질환당뇨병성 신증
주제분류내과학

초록

당뇨병성 신증은 알부민뇨라는 확실한 질병 마커가 존재하고 신증 기전의 주된 병인인 RAS 억제제를 사용함에도 불구하고 일부에서는 지속적으로 진행하여 만성 신부전증으로진행하여, 당뇨병에 의한 만성 신부전증은 나날이 증가 일로에 있다. 이러한 관점에서 볼 때, 당뇨병성 신증 환자에서 혈당, 혈압, 고지혈증의 약물적 치료뿐만 아니라 흡연, 체중감소, 운동 등과 같은 생활습관 교정을 장기간 시행하여 신증을위시한 미세혈관합병증을 60%, 사망이나 심혈관계 질환 발생을 50% 감소시킨 Steno-2 결과를 재조명할 필요가 있다. 즉 현재까지는 당뇨병의 전반적 치료에서 요구되는 것과같이 다양한 위험인자들을 모두 관리하는 것이 신증의 예후를 호전시키는 가장 좋은 방법이다. 그러나 한편으로는 신증의 병태생리에 근거한 신약 개발 및 더 나아가 신장 재생 치료, 즉 줄기세포와 같은 다른 측면의 치료제 개발에도 힘써야할 것이다.

Abstract

Diabetic nephropathy is the leading cause of end-stage renal disease, and is associated with increased risk of cardiovascular disease. Optimal control of blood glucose and blood pressure based on the blockade of renin-angiotensin system is the standard of care for the prevention and treatment of diabetic nephropathy. Regardless of these therapies, the prevalence of diabetic nephropathy continues to increase, highlighting the need for additional therapies. Diabetes affects the progression of kidney disease through a variety of mechanisms; several new therapeutic agents targeting these pathways have been developed, with currently being evaluated in clinical trials.

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