CONCEPTOS ACTUALES SOBRE NEFROPATÍA DIABÉTICA
Palabras clave:
Diabetes mellitus, enfermedad renal crónica, enfermedad renal terminal, neropatía diabética, Key words, chronic renal disease, end stage renal disease, diabetic nephropathy, insulin, ACE inhibitors, angiotensin II receptor blockersResumen
La enfermedad renal del diabético –o nefropatía diabética– es una de las causas más importantes de mortalidad, de enfermedad renal terminal, de terapia de suplencia renal (diálisis y trasplante) y se asocia con una mala calidad de vida. Por lo general el paciente involucrado padece diabetes mellitus por más de 10 años, presenta micro o macroalbuminuria antes de desarrollar una disminución de la filtración glomerular, muestra signos característicos en el estudio de la biopsia renal y puede presentar signos clínicos de daño en otros órganos como en la retina o en los nervios periféricos.
Actualmente la nefropatía diabética se diagnostica de una manera precoz por medio de tamizajes anuales de microalbuminuria y determinaciones de creatinina sérica en los diabéticos, renoprotección con inhibidores del sistema renina-angiotensina-aldosterona, tratamiento de la hipertensión arterial y control de la glicemia a largo plazo, además de los enfoques característicos en la educación del diabético, programas de ejercicio físico, manejo nutricional con dietas balanceadas y fraccionadas, reducción de azúcares refinados, reducción de la ingesta de sodio, de proteínas –o intercambio de algunas de estas por proteínas de origen vegetal– e insulinoterapia –a menudo con un régimen intensivo– para control adecuado de la glicemia.
Palabras clave: Diabetes mellitus, enfermedad renal crónica, enfermedad renal terminal, neropatía diabética, insulina, inhibidores de la ECA, sistema renina-angiotensina-aldosterona, antagonistas del receptor de angiotensina II, bloqueadores de la renina, estatinas, terapia de suplencia renal.
CURRENT CONCEPTS ON DIABETIC NEPHROPATHY
ABSTRACT
Diabetic kidney disease, or diabetic nephropathy, is a most important cause of mortality in end- stage renal disease, renal substitution therapy (dialysis and transplantation) and is associated with poor quality of life. Usually, the patient presents diabetes mellitus for over 10 years, with micro or macroalbuminuria before developing a decrease in glomerular filtration, showing characteristic findings in the study of renal biopsy. They also may have clinical signs of damage to other organs such as the retina or peripheral nerves. Currently, early diagnosis is made through annual screening of microalbuminuria and of serum creatinine levels in known diabetics. Ne- phroprotection with inhibitors of the renin-angiotensin-aldosterone system, treatment of high blood pressure and glycemic control in the long term, besides the characteristic approaches of diabetic education, exercise programs, nutritional management with balanced and fractionated diets, reducing refined sugars, sodium, proteins, or exchanging some of them for vegetal proteins. Insulin therapy is necessary, often with an intensive regime for adequate glycemic control.
Key words: Diabetes mellitus, chronic renal disease, end stage renal disease, diabetic nephropathy, insulin, ACE inhibitors, angiotensin II receptor blockers, renin antagonists, statins, renal substitution therapy.
Biografía del autor/a
Germán Durán Avendaño, Academia Nacional de Medicina
MD, Internista-Nefrólogo, Asociación Médica de los Andes. Miembro de Número de la Asociación Colombiana de Nefrología y
Miembro Correspondiente, Academia Nacional de Medicina, Bogotá.
Germán Gamarra Hernández, Academia Nacional de Medicina
Alfredo Jácome, Academia Nacional de Medicina
MD, FACP. Internista-Endocrinólogo. Miembro Honorario, Asociación Colombiana de Endocrinología, Diabetes y Metabolismo, Miembro de Número, Academia Nacional de Medicina, Bogotá.
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