腎衰竭、原發病因、洗腎、糖尿病

Renal Fellow Network: Diabetes: To Biopsy or not to Biopsy - Part 2: In my experience the appetite to biopsy patients with clinical renal disease varies widely between clinician, institution and country. This...

在申請重大傷病時，常需要填寫「原發病因」，最常寫的是系統性疾病--糖尿病，B-03。而且，目前統計洗腎病人中，大家認為約有近一半是糖尿病所引起的。

但是看了這文章，讓人重新思考，是不是有那麼多的糖尿病腎病變？其他導致洗腎的原因，是不是被我們所忽略了？

620 diabetics病人做腎切片，結果是：37% of patients had DN alone(單純的腎病變), 36% had non-diabetic renal disease (NDRD) alone (單純的非糖尿病腎病變，難怪有些糖尿病病人，進入透析後，仍有很多尿量，雖然他們的毒素都是破表的), and 27% had DN plus NDRD (有糖尿病和非糖尿病腎病變同時存在). 

In NDRD alone: FSGS (22%), hypertensive nephrosclerosis (18%), acute tubular necrosis (ATN) (17%), IgA nephropathy (11%), membranous GN (8%), and pauci-immune GN (7%) comprised 80% of diagnoses.

In DN plus NDRD: ATN (43%), hypertensive nephrosclerosis (19%), FSGS (13%), and IgA nephropathy (7%).

In multivariate analysis longer duration of DM was associated with a greater likelihood of DN and less likelihood of NDRD.

Older age, having DM2 vs DM1, short duration of DM and less proteinuria are more likely in those with NDRD alone vs DN alone in this cohort. 

這些資料可以讓我們再review一下，有些被想當然爾的糖尿病腎病變的病人，可能腎衰竭的原因。