medicina58巻10号

2021年09月発行

特集 腎疾患—エキスパートへの質問で学ぶ診療のキホンと最新情報 糖尿病と腎障害

糖尿病性腎臓病（DKD）の診断と最新治療について教えてください

著者： 滝山由美¹

所属機関： ¹旭川医科大学内科学講座病態代謝・消化器・血液腫瘍制御内科学分野糖尿病内科学部門

ページ範囲：P.1538 - P.1541

Point
◎糖尿病性腎臓病（DKD）の診断には，尿中アルブミン，eGFR（シスタチンC）を測定し，尿検査を施行（沈査を含む），糖尿病網膜症併発の有無から，まずは，non-DKDの鑑別診断後，腎症病期を確定する．
◎糖尿病性腎臓病には，正常アルブミン尿を呈しながら，eGFRが急速低下する非典型例が存在するため，eGFRの経過観察が重要である．加齢，高血圧，動脈硬化，脂質異常症などが病態に関与する．
◎血糖コントロールは，網膜症，神経障害など糖尿病性細小血管障害の予防・進行阻止に重要であるが，腎症に対しては，降圧薬，RAAS阻害薬，SGLT2阻害薬などの腎血行動態改善を標的にした治療がより効果的と言える．

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