III．Diabetic nephropathyとdiabetic kidney disease（腎臓）
糖尿病性腎症は，糖尿病の合併症の1つとして重要である．しかし近年，糖尿病管理の進歩や患者の高齢化，脂質異常，高血圧ならびに動脈硬化等の併存治療が長期化する症例が増加している背景もあり，古典的（典型的）な経過を示さない症例も増えてきている．そのような背景をもとに“糖尿病性腎臓病（diabetic kidney disease：DKD）”の疾患概念が提唱・使用されるようになっている．しかし，旧来の糖尿病性腎症（diabetic nephropathy）との異同や用語の使い分けについては，未だに明確でない．本稿では，糖尿病性腎症の病態・診断及びDKDの概念について概説する．...
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| Published in | 日本内科学会雑誌 Vol. 108; no. 4; pp. 681 - 687 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本内科学会
10.04.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0021-5384 1883-2083 |
| DOI | 10.2169/naika.108.681 |
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| Abstract | 糖尿病性腎症は，糖尿病の合併症の1つとして重要である．しかし近年，糖尿病管理の進歩や患者の高齢化，脂質異常，高血圧ならびに動脈硬化等の併存治療が長期化する症例が増加している背景もあり，古典的（典型的）な経過を示さない症例も増えてきている．そのような背景をもとに“糖尿病性腎臓病（diabetic kidney disease：DKD）”の疾患概念が提唱・使用されるようになっている．しかし，旧来の糖尿病性腎症（diabetic nephropathy）との異同や用語の使い分けについては，未だに明確でない．本稿では，糖尿病性腎症の病態・診断及びDKDの概念について概説する． |
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| AbstractList | 糖尿病性腎症は，糖尿病の合併症の1つとして重要である．しかし近年，糖尿病管理の進歩や患者の高齢化，脂質異常，高血圧ならびに動脈硬化等の併存治療が長期化する症例が増加している背景もあり，古典的（典型的）な経過を示さない症例も増えてきている．そのような背景をもとに“糖尿病性腎臓病（diabetic kidney disease：DKD）”の疾患概念が提唱・使用されるようになっている．しかし，旧来の糖尿病性腎症（diabetic nephropathy）との異同や用語の使い分けについては，未だに明確でない．本稿では，糖尿病性腎症の病態・診断及びDKDの概念について概説する． |
| Author | 古市, 賢吾 和田, 隆志 |
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| References | 16) Nowak N, et al: Increased plasma kidney injury molecule-1 suggests early progressive renal decline in non-proteinuric patients with type 1 diabetes. Kidney Int 89: 459-467, 2016. 17) Chronic Kidney Disease Biomarkers Consortium Investigators: Association of urinary KIM-1, L-FABP, NAG and NGAL with incident end-stage renal disease and mortality in American Indians with type 2 diabetes mellitus. Diabetologia 58: 188-198, 2015. 7) 和田隆志, 湯澤由紀夫監修, 佐藤 博, 他編: 糖尿病性腎症と高血圧性腎硬化症の病理診断への手引き. 東京医学社, 2015. 1) Afkarian M, et al: Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014. JAMA 316: 602-610, 2016. 4) Furuichi K, et al: Clinico-pathological features of kidney disease in diabetic cases. Clin Exp Nephrol 22: 1046-1051, 2018. 12) Kanazawa Study Group for Renal Diseases and Hypertension: Long-term outcomes of Japanese type 2 diabetic patients with biopsy-proven diabetic nephropathy. Diabetes Care 36: 3655-3662, 2013. 5) Research Group of Diabetic Nephropathy and Nephrosclerosis, Ministry of Health, Labour and Welfare of Japan, and Japan Agency for Medical Research and Development: Nationwide multicenter kidney biopsy study of Japanese patients with hypertensive nephrosclerosis. Clin Exp Nephrol 22: 629-637, 2018. 15) Vaidya VS, et al: Regression of microalbuminuria in type 1 diabetes is associated with lower levels of urinary tubular injury biomarkers, kidney injury molecule-1, and N-acetyl-β-D-glucosaminidase. Kidney Int 79: 464-470, 2011. 18) Niewczas MA, et al: Circulating TNF receptors 1 and 2 predict ESRD in type 2 diabetes. J Am Soc Nephrol 23: 507-515, 2012. 6) Tervaert TW, et al: Pathologic classification of diabetic nephropathy. J Am Soc Nephrol 21: 556-563, 2010. 11) Toyama T, et al: The impacts of albuminuria and low eGFR on the risk of cardiovascular death, all-cause mortality, and renal events in diabetic patients: meta-analysis. PLoS One 8: e71810, 2013. 3) Sharma SG, et al: The modern spectrum of renal biopsy findings in patients with diabetes. Clin J Am Soc Nephrol 8: 1718-1724, 2013. 14) Morita M, et al: Association of urinary type IV collagen with GFR decline in young patients with type 1 diabetes. Am J Kidney Dis 58: 915-920, 2011. 9) Hoshino J, et al: A new pathological scoring system by the Japanese classification to predict renal outcome in diabetic nephropathy. PLoS One 13: e0190923, 2018. 2) Qi C, et al: Classification and Differential Diagnosis of Diabetic Nephropathy. J Diabetes Res 2017: 8637138, 2017. 10) Wada T, et al: Clinical impact of albuminuria and glomerular filtration rate on renal and cardiovascular events, and all-cause mortality in Japanese patients with type 2 diabetes. Clin Exp Nephrol 18: 613-620, 2014. 13) Araki S, et al: Association between urinary type IV collagen level and deterioration of renal function in type 2 diabetic patients without overt proteinuria. Diabetes Care 33: 1805-1810, 2010. 8) Furuichi K, et al: Nationwide multicentre kidney biopsy study of Japanese patients with type 2 diabetes. Nephrol Dial Transplant 33: 138-148, 2018. 19) Gohda T, et al: Circulating TNF receptors 1 and 2 predict stage 3 CKD in type 1 diabetes. J Am Soc Nephrol 23: 516-524, 2012. |
| References_xml | – reference: 6) Tervaert TW, et al: Pathologic classification of diabetic nephropathy. J Am Soc Nephrol 21: 556-563, 2010. – reference: 14) Morita M, et al: Association of urinary type IV collagen with GFR decline in young patients with type 1 diabetes. Am J Kidney Dis 58: 915-920, 2011. – reference: 16) Nowak N, et al: Increased plasma kidney injury molecule-1 suggests early progressive renal decline in non-proteinuric patients with type 1 diabetes. Kidney Int 89: 459-467, 2016. – reference: 5) Research Group of Diabetic Nephropathy and Nephrosclerosis, Ministry of Health, Labour and Welfare of Japan, and Japan Agency for Medical Research and Development: Nationwide multicenter kidney biopsy study of Japanese patients with hypertensive nephrosclerosis. Clin Exp Nephrol 22: 629-637, 2018. – reference: 10) Wada T, et al: Clinical impact of albuminuria and glomerular filtration rate on renal and cardiovascular events, and all-cause mortality in Japanese patients with type 2 diabetes. Clin Exp Nephrol 18: 613-620, 2014. – reference: 15) Vaidya VS, et al: Regression of microalbuminuria in type 1 diabetes is associated with lower levels of urinary tubular injury biomarkers, kidney injury molecule-1, and N-acetyl-β-D-glucosaminidase. Kidney Int 79: 464-470, 2011. – reference: 9) Hoshino J, et al: A new pathological scoring system by the Japanese classification to predict renal outcome in diabetic nephropathy. PLoS One 13: e0190923, 2018. – reference: 13) Araki S, et al: Association between urinary type IV collagen level and deterioration of renal function in type 2 diabetic patients without overt proteinuria. Diabetes Care 33: 1805-1810, 2010. – reference: 8) Furuichi K, et al: Nationwide multicentre kidney biopsy study of Japanese patients with type 2 diabetes. Nephrol Dial Transplant 33: 138-148, 2018. – reference: 7) 和田隆志, 湯澤由紀夫監修, 佐藤 博, 他編: 糖尿病性腎症と高血圧性腎硬化症の病理診断への手引き. 東京医学社, 2015. – reference: 11) Toyama T, et al: The impacts of albuminuria and low eGFR on the risk of cardiovascular death, all-cause mortality, and renal events in diabetic patients: meta-analysis. PLoS One 8: e71810, 2013. – reference: 19) Gohda T, et al: Circulating TNF receptors 1 and 2 predict stage 3 CKD in type 1 diabetes. J Am Soc Nephrol 23: 516-524, 2012. – reference: 4) Furuichi K, et al: Clinico-pathological features of kidney disease in diabetic cases. Clin Exp Nephrol 22: 1046-1051, 2018. – reference: 3) Sharma SG, et al: The modern spectrum of renal biopsy findings in patients with diabetes. Clin J Am Soc Nephrol 8: 1718-1724, 2013. – reference: 17) Chronic Kidney Disease Biomarkers Consortium Investigators: Association of urinary KIM-1, L-FABP, NAG and NGAL with incident end-stage renal disease and mortality in American Indians with type 2 diabetes mellitus. Diabetologia 58: 188-198, 2015. – reference: 18) Niewczas MA, et al: Circulating TNF receptors 1 and 2 predict ESRD in type 2 diabetes. J Am Soc Nephrol 23: 507-515, 2012. – reference: 1) Afkarian M, et al: Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014. JAMA 316: 602-610, 2016. – reference: 2) Qi C, et al: Classification and Differential Diagnosis of Diabetic Nephropathy. J Diabetes Res 2017: 8637138, 2017. – reference: 12) Kanazawa Study Group for Renal Diseases and Hypertension: Long-term outcomes of Japanese type 2 diabetic patients with biopsy-proven diabetic nephropathy. Diabetes Care 36: 3655-3662, 2013. |
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| SubjectTerms | バイオマーカー 糖尿病性腎症 糖尿病性腎臓病（DKD） 腎生検 |
| Title | III．Diabetic nephropathyとdiabetic kidney disease（腎臓） |
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