1、Stage of Diabetic nephropathyStage 1-Hyperfiltration phaseStage of Diabetic nephropathyStage 2-Silent phaseStage of Diabetic nephropathyStage 3-Microalbuminuria phaseBlood pressure(mm Hg)7:00 11:00 15:00 19:0 23:00 3:00 7:00SleepDipperNon-dipperTime of day175135115957555155Stage of Diabetic nephropa
2、thyStage 4-Macroalbuminuria phaseStage of Diabetic nephropathyStage 4-Macroalbuminuria phaseStage of Diabetic nephropathyStage 5-ESRDThe importance ofMicroalbuminuriaDiagnosis ofMicroalbuminuriaScreening ofMicroalbuminuriaRegression ofMicroalbuminuriaAmerican Familial Physician 72:96-99,2005Microalb
3、uminuriaMonitor CreatinineInvestigate forOther RenalDiseaseScreen forHeart DiseaseScreen forVascular DiseaseScreen forEye DiseaseOptimizeLipidsOptimizeGlucoseDiscourageSmokingOptimizeBPNo BiopsyRenal biopsyIntroduction of Hypertensive Kidney DiseaseIntroduction of Hypertensive Kidney DiseaseKidney I
4、nt 64:2331-2341,2003Introduction of Hypertensive Kidney DiseaseKidney Int 68:S52-S56,2005JAMA 289:2561,2003From JNC 7Kidney Blood Press Res 25:341-353,2002Kidney Int 64:2331-2341,2003Nephrol Dial Transplant 28:517-523,2003Kidney Blood Press Res 25:341-353,2002Kidney Blood Press Res 25:341-353,2002Ki
5、dney Blood Press Res 25:341-353,2002Kidney Blood Press Res 25:341-353,2002Kidney Blood Press Res 25:341-353,2002Kidney Int 64:2331-2341,2003Kidney Int 68:S52-S56,2005Am J Kidney Dis 23:655-660,1994Kidney Int 68:S52-S56,2005Kidney Int 54(S68):S55-59,1998Nephrol Dial Transplant 15:1801-1807,2000Kidney
6、 Int 51:244-252,1997Nephrol Dial Transplant 28:517-523,2003Kidney Int 64:2331-2341,2003Kidney Int 68:S52-S56,2005Nephrol Dial Transplant 28:517-523,2003JAMA 288:2421-2431,2002JAMA 288:2421-2431,2002JAMA 288:2421-2431,2002JAMA 288:2421-2431,2002JAMA 288:2421-2431,2002JAMA 288:2421-2431,2002300 mg/day
7、Kidney Int 64:2331-2341,2003J Am Soc Nephrol 17:S250-254,2006v45 patients with primary proteinuric nephropathies After 6 months of medicationvLisinopril 40 mg proteinuria 50%vCandesartan 32mg proteinuria 48%vLisinopril 20 mg+Candesartan 16mg proteinuria 70%BP was reduced significantly but no differe
8、nce between groupsKidney Int Suppl 82:S47-52,2002vCombination therapy reduced proteinuria more effectively than monotherapyvDual blockade reduced the risk of ESRD more effectively than monotherapy(a study with 263 Japanese in 2003)vAdverse effectsHyperkalemia:most frequentAnemia:RAS stimulates erythropoietin synthesis J Am Soc Nephrol 17:S250-254,2006Kidney Int 68:S52-S56,2005
