細小血管障害―特に腎症について

Diagnosis of diabetic kidney disease

　糖尿病性腎症の診断には，尿中アルブミン排泄量の測定が必須である．24時間蓄尿ではなく，随時尿を用いたアルブミン・クレアチニン比(ACR)で評価されることが多いが，用いる尿検体は，日差変動がより少ない早朝尿を用いることが勧められる．一方近年内外のガイドラインで提唱されている慢性腎臓病(CKD)は，推算糸球体濾過量(eGFR)によってステージが分けられているが，日本人糖尿病患者におけるeGFRの評価は今後の課題である．

Albuminuria is a fundamental manifestation of diabetic kidney disease.　Urinary ACR (albumin-to-creatinine ratio) is usually measured in random spot urineu;uhowever, using a first-morning urine specimen is recommended to minimize intraindividual variation.　Normo-, micro, and macroalnuminuria are defined as an ACR ＜ 30, 30-299, and ≥ 300 mg/g, respectively.　Recently, CKD (chronic kidney disease) has been defined, irrespective of cause, as the presence of kidney damage that is most frequently detected as persistent albuminuria and/or decreased GFR (glomerular filtration rate).　GFR is estimated using the equation proposed by the Japanese Society for Nephrology.　Clinical significance of estimated GFR in diabetic patients needs to be determined.