:

;
;

...

-
-
-
:
24
30mg <300mg

2400 mg

2 30mg
24

Despopoulos, Color Atlas of Physiology

2003 Thieme

 :
(;)
:

..
,

:





Diabetes Research and Clinical Practice 2008

Diabetologia 2008

Diabetologia 1989
Am J Kidney Dis 1999
Hypertension 2000
Nephrol Dial Transplant 2004
Clin Sci 2005
Diabetologia 2008
Diabetologia 2012

(mg/24h)

(g/min)
AER

(mg/mg)
ACR

< 30

< 20

< 30

30 300

20- 200

30 300

> 300

>200

> 300

dipstick

screening
95%
93%

1+

Ann Intern Med, October 2011

1.
2.

3.
4.
5.

NATIONAL KIDNEY FOUNDATION

 1
5
(7-10)
15

30-45% .
( 10
)

ADA 2011

Perkins et al., NEJM2003;348:2285

Mogensen et al., NEJM 1984;311:89
Caramori et al.,
Diabetes2000;49:1399

DCCT/EDIC study
Arch Intern Med. 2011

Diabetes 2009

Diabetic Medicine 2008

Urine Dipstick to Detect Trace Proteinuria: An

Underused Tool for an
Underappreciated Risk Marker

464,709
Am J Kidney Dis. 2011 (Editorial)


(HOPE)

JAMA 2001

Circulation 2004


2
The Renal Insufficiency And Cardiovascular Events (RIACE) Italian
Multicenter Study

15.773

Diabetes Care 2012

Atherosclerosis 2011


()

12 , 48.596

Stroke 2010

Estimated Glomerular Filtration Rate and

Albuminuria
as Predictors of Outcomes in Patients With High
Cardiovascular Risk
A Cohort Study
(ONTARGET TRANSCEND trials)

AER eGFR

Ann Intern Med 2011

;

;


GFR 1 -

. +
. +
Am J Nephrol 2008


GFR 2 -

. +
. +
. +

Am J Nephrol 2008


2
N Engl J Med 2004

Bergamo Nephrologic Diabetes

Complications
Trial (BENEDICT)

Effects of verapamil added-on trandolapril

therapy in hypertensive type 2 diabetes patients
with microalbuminuria: the BENEDICT-B
randomized trial







.
J of Hypertens 2011



2:

:
--

(OR 1.66, 95% CI 1.22-2.27)

--

(OR 0.62, CI
Diabet Med. 2011

0.38-1.02)



3 DIRECT
(Diabetic Retinopathy Candesartan Trials)

Ann Intern Med 2009

ROADMAP study
2

HR 4.94 (95% CI = 1.4317.06)

N Engl J Med 2011

 vs

ACCORD study
Lancet 2011

:
: