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Artículo de revisión
Enviado: 2015-04-01
Publicado: 2014-02-18

DESARROLLO Y PROGRESIÓN DE LA NEFROPATÍA DIABÉTICA EN DIABETES TIPO 2: UN ENFOQUE DESDE LOS ESTUDIOS CLÍNICOS

Universidad del Tolima
Diabetes Mellitus Nefropatías Diabéticas Insuficiencia Renal Crónica

Resumen

INTRODUCCIÓN: El 28% de los pacientes diabéticos atendidos en cuidado primario tiene enfermedad renal crónica. La nefropatía diabética es causa del 40% de los ingresos a programa crónico de diálisis en Colombia. En los últimos años se han realizado grandes ensayos clínicos sobre nefropatía diabética. La presente revisión actualiza la información que estos estudios han aportado sobre el desarrollo y progresión de la nefropatía secundaria a diabetes tipo 2 en términos de ingesta proteica, presión arterial y control glucémico.

METODOLOGÍA: Se desarrolló una estrategia de búsqueda tipo “snowball” partiendo de una revisión no sistemática de la literatura. Para la búsqueda se utilizó la base de datos MEDLINE incluyendo artículos con el término MeSH “diabetic nephropathy” publicados entre el 2010 y 2013 en el Idioma Español o Inglés.

RESULTADOS:El control intensivo de la glucemia no siempreconduce a mejores desenlaces, la HbA1c <6% se asocia con mayor mortalidad.Varios autores sugieren que la meta de HbA1c debería ser individualizada teniendo en cuenta laduración de la diabetes,la presencia de complicaciones microvasculares y macrovasculares, y la expectativa de vida. Recientemente se ha propuesto un modelo de efecto dual y dinámico de la HbA1c en el que la tasa de filtración glomerular actual tiene relación negativa con la HbA1c previa y relación positiva con la HbA1c actual.

Las guías recomiendan reducciones en presión diastólica hasta 80-85 mm Hg. Los estudios actuales no constituyen soporte para recomendar una presión sistólica menor de 130 mm Hg.

No existe evidencia conclusiva que vincule la restricción proteica con una menor tasa de progresión de la nefropatía diabética.

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Citas

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Cómo citar

Coronado Suescún, C. Y. (2014). DESARROLLO Y PROGRESIÓN DE LA NEFROPATÍA DIABÉTICA EN DIABETES TIPO 2: UN ENFOQUE DESDE LOS ESTUDIOS CLÍNICOS. Desafíos, 1(8). Recuperado a partir de http://revistas.ut.edu.co/index.php/desafios/article/view/455