[논문]소아청소년기 당뇨병성 신병증(I); 임상 소견을 중심으로

하태선

doi:10.3339/jkspn.2009.13.1.1

소아청소년기 당뇨병성 신병증(I); 임상 소견을 중심으로
Diabetic Nephropathy in Childhood and Adolescence (I) : Clinical Features 원문보기

대한소아신장학회지 = Journal of the Korean society of pediatric nephrology, v.13 no.1, 2009년, pp.1 - 13

초록
AI-Helper

소아청소년기의 당뇨병은 대부분 제1형 당뇨병이나 최근 우리나라를 포함한 서구 사회에서는 제2형 당뇨병의 빈도가 증가하고 있다. 임상소견 상 제1형 당뇨병은 여러 위험인자에 의하여 비교적 전형적인 단계를 거치면서 미세알부민뇨와 당뇨병성 신병증으로 진행하면서 만성 신질환으로 발전하게 되며, 제2형 당뇨병은 비전형적 임상경과를 거치나 신병증 진행율이 높아서, 실제로 당뇨병성 신병증은 전세계 신장대체요법이 필요한 말기 신질환의 가장 많은 원인이며 국내에서도 꾸준히 원인 질환으로서 증가 중이다. 당뇨병이 사춘기 전에 발생하는 경우보다 사춘기나 그 이후에 발생하는 경우에 혈관합병증의 발생이 증가하므로, 사춘기가 위험인자로 작용하며, 이것은 유병기간과 함께 사춘기 전에 소아 당뇨병성 신병증이 발생하는 경우는 매우 드문 이유이다. 제1형과 제2형 당뇨병에서 신병증은 비슷하게 15-25%에서 발병하며, 당뇨병성 신병증과 만성 신질환으로 진행하는 과정 중에 가장 중요한 표식자인 미세알부민뇨는 위험인자이고 병리학적 소견과 관련이 있다.

Abstract ▼ AI-Helper

Type 1 diabetes mellitus commonly occurs in childhood and adolescence, although the prevalence of type 2 diabetes mellitus in these age groups is now being increased in the western world and Korea. Diabetic nephropathy developing in 15-25% of subjects with type 1 diabetes mellitus and in similar or higher percentage of type 2 diabetes mellitus patients is the leading cause of end-stage renal disease worldwide. Although prepubertal diabetic duration may contribute less to the development of microvascular complications than pubertal and postpubertal duration, diabetic nephropathy in susceptible patients almost certainly begins soon after disease onset and may accelerate during adolescence, leading to microalbuminuria or incipient DN. Type 1 diabetes is commonly associated with a period of hyperfiltration followed by the development of persistent microalbuminuria after as little as 7-10 years of type 1 diabetes. Microalbuminuria is associated with pathologic lesions that are so advanced as to overlap with those seen in patients with overt proteinuria and declining kidney function, therefore, microalbuminuria currently considered the best clinical indicator of overt diabetic nephropathy risk. This review covers the natural history and renal manifestations of diabetic nephropathy in children and adolescents.

주제어

AI 본문요약
AI-Helper

* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.

문제 정의

본 논문에서는 소아청소년기 당뇨병성 신병증(diabetic nephropathy)을 중심으로 이의 임상상과 발병기전 그리고 이에 따른 치료를 중심으로 2회에 걸쳐 정리하고자 한다.

질의응답

핵심어	질문	논문에서 추출한 답변
	당뇨병성 신병증이 특징으로 하는 알부민뇨는 정도에 따라 어떻게 분류되는가?	당뇨병성 신병증은 지속적 알부민뇨를 특징으로 하고 사구체여과율의 감소와 혈압의 증가를 보인다[17]. 알부민뇨는 정도에 따라, 30-300 mg/일 정도의 미세알부민뇨(microalbuminuria)와 300 mg/일 이상의 거대알부민뇨(macroalbuminuria)로 나눌 수 있다[1, 17].
	당뇨병이란 무엇인가?	당뇨병은 인슐린 분비부족이나 작용의 결함으로 인한 지속적 고혈당증과 단백질, 지질대사이상에 의해 생기는 대사성 질환이다[1, 2]. 당뇨병은 다양한 유형을 포함하는 증후군으로서, 과거에는 임상 양상에 따라 인슐린 의존성 당뇨병(insulin-dependent diabetes mellitus, IDDM)과 인슐린 비 의존성 당뇨병(noninsulin-dependent diabetes mellitus, NIDDM)으로 분류하였으나[3], 이러한 임상적 소견에 따른 분류에는 많은 문제점이 있었고, 이후 당뇨병의 병인에 대한 연구가 활발히 진행됨에 따라, 1997년 미국 당뇨병학회(American diabetes association, ADA) [4]와 1999년 WHO [5]에 의해 당뇨병의 원인적인 특성에 따라 당뇨병을 제1형, 제2형, 기타 특이형태의 당뇨병(2차성 당뇨병), 임신성 당뇨병 등으로 분류한 방법이 널리 사용되고 있다.
	당뇨병은 과거 임상 양상에 따라 무엇으로 분류하였는가?	당뇨병은 인슐린 분비부족이나 작용의 결함으로 인한 지속적 고혈당증과 단백질, 지질대사이상에 의해 생기는 대사성 질환이다[1, 2]. 당뇨병은 다양한 유형을 포함하는 증후군으로서, 과거에는 임상 양상에 따라 인슐린 의존성 당뇨병(insulin-dependent diabetes mellitus, IDDM)과 인슐린 비 의존성 당뇨병(noninsulin-dependent diabetes mellitus, NIDDM)으로 분류하였으나[3], 이러한 임상적 소견에 따른 분류에는 많은 문제점이 있었고, 이후 당뇨병의 병인에 대한 연구가 활발히 진행됨에 따라, 1997년 미국 당뇨병학회(American diabetes association, ADA) [4]와 1999년 WHO [5]에 의해 당뇨병의 원인적인 특성에 따라 당뇨병을 제1형, 제2형, 기타 특이형태의 당뇨병(2차성 당뇨병), 임신성 당뇨병 등으로 분류한 방법이 널리 사용되고 있다.

참고문헌 (107)

Ahn HS. Pediatrics. 9th ed. Seoul: Daehan Textbook Co, 2007:965-78.
Feld LG. Diabetic nephropathy. In: Avner ED eds. Pediatric Nephrology. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2004;931-9
National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979;28:1039-57.

상세보기
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183-97.

상세보기
World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Geneva: World Health Organization 1999
Amos AF, McCarty DJ. Zimmet P. The rising global burden of diabetes and its complication: Estimates and projections to the year 2010. Diabetic Med 1997;14(Suppl 5):S7-85.

상세보기
Rhee BD. Epidemiological characteristics of diabetes mellitus among Korean population. J Korean Diabetes Assoc 2003;27:173-8.
Yoon KH. Pathogenesis of type 2 diabetes in Korea. J Korean Diabetes Assoc 2002;24:397-403.
Park SW, Yun YS, Song YD, Lee HC, Huh KB. Pathogenetic heterogeneity of type 2 diabetes mellitus in Korea. J Korean Diabetes Assoc 1999;23:62-9.
Ko KS, Hong SK, Lee KU, Kim NH, Choi DS, Ihm SH, et al. The frequency of ICA and anti-GAD antibody in Korean IDDM and NIDDM patients. J Korean Diabetes Assoc 1998;22:312-9.
Min HK. Clinical characteristics of diabetes in Korea. J Korean Diabetes Assoc 1992;16:163-74.
DIAMOND Project Group. Incidence and trends of childhood type 1 diabetes worldwide 1990-1999. Diabet Med 2006;23:857-66

상세보기
Karvonen M, Viik-Kajander M, Moltchnova E, Libman I, LaPorte R, Tuomilehto J. Incidence of type I diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care 2000;23:1516-26.

상세보기
The Korean Society of Pediatric Endocrinology. Pediatric Endocrinology. Seoul: Kwangmoon Press, 1996;239-42.
Kim HK, Kim JY, Park JY, Yoo B, Lee KU, Kim GS, et al. Clinical typing and characterization of youth-onset diabetic patients in Korea. J Korean Diabetes Assoc 1995;19:202-7.
Kang DC, Yoo EG, Kim DH. Growth status in children with type 1 and 2 diabetes mellitus. J Korean Soc Pediatr Endocrinol 2003;7:61-8.
Parving H-H, Mauer M, Ritz E. Diabetic nephropathy. In: Brenner BM ed. The Kidney. WB Saunders, Philadelphia, PA: 2008;1265-98
Rossing P. The changing epidemiology of diabetic microangiopathy in type 1 diabetes. Diabetologia. 2005;48:1439-44.

상세보기
Hovind P, Tarnow L, Rossing K, Rossing P, Eising S, Larsen N, et al. Decreasing incidence of severe diabetic microangiopathy in type 1 diabetes. Diabetes Care 2003;26:1258-64.

상세보기
Andersen AR, Christiansen JS, Andersen JK, Kreiner S, Deckert T. Diabetic nephropathy in Type 1 (insulin-dependent) diabetes: and epidemiological study. Diabetologia 1983;25:496-501.

상세보기
Breyer JA. Diabetic nephropathy in insulindependent patients. Am J Kidney Dis 1992;20:533-47.

상세보기
Olsen BS, Sjolie AK, Hougaard P, Johannesen J, Marinelli K, Jacobsen BB, et al. The significance of the prepubertal diabetes duration for the development of retinopathy and nephropathy in patients with type 1 diabetes. J Diabetes Complications 2004;18:160-4.

상세보기
Svensson M, Nystrom L, Schon S, Dahlquist G. Age at onset of childhood-onset type 1 diabetes and the development of end-stage renal disease. Diabetes Care 2006;29:538-42.

상세보기
United States Renal Data System: Excerpts from the USRDS 2001 Annual Data Report. Am J Kidney Dis 2001;38(suppl 3):S1-248.
US Renal Data System: USRDS 2008 Annual Data Report. Bethesda MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases 2007
Stengel B, Billon S, Van Dijk PC, Jager KJ, Dekker FW, Simpson K, et al. Trends in the incidence of renal replacement therapy for end-stage renal disease in Europe. Nephrol Dial Transplant 2003;18:1824-33.

상세보기
ESRD Registry Committee, Korean Society of Nephrology. Current renal replacement therapy in Korea. Korean J Nephrol (Abstract) 2007;26:459-81.
ESRD Registry Committee, Korean Society of Nephrology. Current renal replacement therapy in Korea. Korean J Nephrol 1999;3(Suppl 8):S343-54.
ESRD Registry Committee, Korean Society of Nephrology. Current renal replacement therapy in Korea. Korean J Nephrol 1994;13(Suppl 8):S1-16.
US Renal Data System: USRDS 2006 Annual Data Report. Bethesda MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases 2005
Mathiesen ER, Ronn B, Storm B, Foght H, Deckert T. The natural course of microalbuminuria in insulin-dependent diabetes : A 10-year prospective study. Diabet Med 1995;12:482-7.

상세보기
Bogdanovic R. Diabetic nephropathy in children and adolescents. Pediatr Nephrol 2008;23:507-25.

상세보기
Ha SK. Epidemiology and clinical course of diabetic nephropathy; Is there any differences in prevalence and incidence of diabetic nephropathy between type 1 and type 2 diabetes mellitus? Korean J Nephrol 2005;24:865-71.
Harvey JN, Rizvi K, Craney L, Messenger J, Shah R, Meadows PA. Population-based survey and analysis of trends in the prevalence of diabetic nephropathy in type 1 diabetes. Diabet Med 2001:18:998-1002

상세보기
Caramori ML, Fioretto P, Mauer M. Enhancing the predictive value of urinary albumin for diabetic nephropathy. J Am Soc Nephrol 2006;17:339-52

상세보기
Ibrahim HAA, Vora JP. Diabetic nephropathy. Best Pract Res Clin Endocrinol Metab 1999;13:239-64.

상세보기
Vora JP, Dolben J, Dean JD, Thomas D, Williams JD, Owens DR, et al. Renal hemodynamics in newly presenting non-insulin dependent diabetes mellitus. Kidney Int 1992;41:829-35.

상세보기
Caramori ML, Fioretto P, Mauer M. The need for early predictors of diabetic nephropathy risk. Diabetes 2000;49:1399-408.

상세보기
Fagot-Campagna A, Knowler WC, Pettitt DJ. Type 2 diabetes in Pima Indian children: cardiovascular risk factors at diagnosis and 10 years later. Diabetes 1998;47(Suppl 1):A155(abstract).

상세보기
Pavkov ME, Bennett PH, Knowler WC, Krakoff J, Sievers ML, Nelson RG. Effect of youthonset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians. JAMA 2006;296:421-6.

상세보기
Dean H, Flett B. Natural history of type 2 diabetes diagnosed in childhood: Long term follow-up in young adult years. Diabetes 2002;51(Suppl 2):A25-6.

상세보기
Yokoyama H, Okudaira M, Otani T, Takaike H, Miura J, Saeki A, et al. Existence of earlyonset NIDDM Japanese demonstrating severe diabetic complications. Diabetes Care 1997;20:844-7.

상세보기
DCCT/EDIC Research Group. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med 2000;342:381-9.

상세보기
DCCT/EDIC Research Group. Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA 2002;287:2563-9.

상세보기
DCCT/EDIC Research Group. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy. JAMA 2003;290:2159-67.

상세보기
DCCT/EDIC Research Group. Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). J Pediatr 2001;139:804-12.

상세보기
Bangstad HJ, Osterby R, Dahl-Jorgensen K, Berg KJ, Hartmann A, Hanssen KF. Improvement of blood glucose control in IDDM patients retards the progression of morphological changes in early diabetic nephropathy. Diabetologia 1994;37:483-90.

상세보기
Yokoyama H, Okudaira M, Otani T, Watanabe C, Takaike H, Miuira J, et al. High incidence of diabetic nephropathy in early-onset Japanese NIDDM patients. Diabetes Care 1998;21:1080-5.

상세보기
Eppens MC, Craig ME, Cusumano J, Hing S, Chan AK, Howard NJ, et al. Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes. Diabetes Care 2006;29:1300-6.

상세보기
Svensson M, Sundkvist G, Arnqvist H, Bjork E, Blohme G, Bolinder J, et al. Signs of nephropathy may occur early in young adults with diabetes despite modern diabetes management. Diabetes Care 2003;26:2903-9.

상세보기
Hasslacher CH, Ritz E, Wahl P, Michael C. Similar risks of nephropathy in patients with type 1 or type 2 diabetes mellitus. Nephrol Dial Transplant 1989;4:859-63.

상세보기
Humphrey LL, Ballard DJ, Frohnert PP, Chu CP, O'Fallon WM, Palumbo PJ. Chronic renal failure in non-insulin-dependent diabetes mellitus: a population-based study in Rochester, Minnesota. Ann Intern Med 1989;111:788-96.

상세보기
Bojestig M, Arnqvist HJ. Hermansson G, Karlberg BE, Ludvigsson J. Declining incidence of nephropathy in insulin-dependent diabetes mellitus. N Engl J Med 1994;330:15-28.

상세보기
Harvey JN, Allagoa B. The long-term renal and retinal outcome of childhood-onset type 1 diabetes. Diabet Med 2004;21:26-31.

상세보기
Jones CA, Leese GP, Kerr S, Bestwick K, Isherwood DI, Vora JP, et al. Development and progression of microalbuminuria in a clinic sample of patients with insulin dependent diabetes mellitus. Arch Dis Child 1998;78:518-23.

상세보기
Rudberg S, Ullman E, Dahlquist G. Relationship between early metabolic control and the development of microalbuminuria - a longitudinal study in children with type-1 (insulindependent) diabetes mellitus. Diabetologia 1993;36:1309-14.

상세보기
Twyman S, Rowe D, Mansell P, Schapira D, Betts P, Leatherdale B. Longitudinal study of urinary albumin excretion in young diabetic patients-Wessex diabetic nephropathy project. Diabet Med 2001;18:402-8.

상세보기
Olsen BS, Sjolie AK, Hougaard P, Johannesen J, Marinelli K, Jacobsen BB, Mortensen HB; Danish Study Group of Diabetes in Childhood. The significance of the prepubertal diabetes duration for the development of retinopathy and nephropathy in patients with type 1 diabetes. J Diabetes Compl 2004;18:160-4.

상세보기
Svensson M, Eriksson JW, Dahlquist G. Early glycemic control, age at onset, and development of microvascular complications in childhood-onset type diabetes. Diabetes Care 2004;27:955-62.

상세보기
Schultz CJ, Konopelska-Bahu T, Dalton RN, Carroll TA, Stratton I, Gale EA, et al. Microalbuminuria prevalence varies with age, sex, and puberty in children with type 1 diabetes followed from diagnosis in a longitudinal study. Oxford Regional Study Group. Diabetes Care 1999;22:495-502.

상세보기
Holl W, Grabert M, Thon A, Heinze E. Urinary excretion of albumin in adolescents with type 1 diabetes. Diabetes Care 1999;22:1555-60.

상세보기
Sochett E, Daneman D. Early diabetes-related complications in children and adolescents with type 1 diabetes. Endocrinol Metab Clin North Am 1999;128:865-82.
Donaghue KC, Fairchild JM, Craig ME, Chan AK, Hing S, Cutler LR, et al. Do all prepubertal years of diabetes duration contribute equally to diabetes complications? Diabetes Care 2003;26:1224-9.

상세보기
Gallego PH, Bulsara MK, Frazer F, Lafferty AR, Davis EA, Jones TW. Prevalence and risk factors for microalbumin uria in a populationbased sample of children and adolescents with T1DM in Western Australia. Pediatr Diabetes 2006;7:165-72.

상세보기
Lawson ML, Sochett EB, Chait PG, Balfe JW, Daneman D. Effect of puberty on markers of glomerular hypertrophy and hypertension in IDDM. Diabetes 1996;45:51-5.

상세보기
Barkai L, Vamosi I, Lukacs K. Enchanced progression of urinary albumin excretion in IDDM during puberty. Diabetes Care 1998;21: 1019-23.

상세보기
Lane PH. Diabetic kidney disease: impact of puberty. Am J Physiol 2002;283:589-600.
Amin R, Schultz C, Ong K, Frystyk J, Dalton RN, Perry L, et al. Low IGF-I and elevated testosterone during puberty in subjects with type 1 diabetes developing microalbuminuria in comparison to normoalbuminuric control subjects. Diabetes Care 2003;26:1456-61.

상세보기
Amin R, Williams RM, Frystyk J, Ummpleby M, Matthewst D, Orskov H, et al. Increasing urine albumin excretion is associated with growth hormone hypersecretion and reduced clearance of insulin in adolescents and young adults with type 1 diabetes: The Oxford Regional Prospective Study. Clin Endocrinol 2005;62:137-44.

상세보기
Stone ML, Craig ME, Chan AK, Lee JW, Verge CF, Donaghue KC. Natural history and risk factors for microalbuminuria in adolescents with type 1 diabetes. Diabetes Care 2006;29:2072-7.

상세보기
Gilbert RE, Cooper ME, McNally PG, O'Brien RC, Taft J, Jerums G. Microalbuminuria: Prognostic and therapeutic implications in diabetes mellitus. Diabet Med 1994;11:636-45.

상세보기
Salardi S, Cacciari E, Pascucci MG, Giambiasi E, Tacconi M, Tazzari R, et al. Microalbuminuria in diabetic children and adolescents : Relationship with puberty and growth hormone. Acta Paediatr Scand 1990;79:437-43.

상세보기
Quattrin T, Waz WR, Duffy LC, Sheldon MW, Campos SP, Albini CH, et al. Microalbuminuria in an adolescent cohort with insulin-dependent diabetes mellitus. Clin Pediatr(Phila) 1995;34:12-7.

상세보기
Moore TH, Shield JP; Microalbuminuria in Diabetic Adolescents and Children (MIDAC) Research Group. Prevalence of abnormal urinary albumin excretion in adolescents and children with insulin dependent diabetes: The MIDAC study. Arch Dis Child 2000;83:239-43.

상세보기
Hovind P, Tarnow L, Rossing P, Jensen BR, Graae M, Torp I, et al. Predictors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes: inception cohort study. BMJ 2004;328:1105-9.

상세보기
Rossing P, Hougaard P, Parving HH. Progression of microalbuminuria in type 1 diabetes: ten year prospective observational study. Kidney Int 2005;68:1446-50.

상세보기
Dahlquist G, Stattin EL, Rudberg S. Urinary albumin excretion rate in the prediction of diabetic nephropathy; a longterm follow-up study of childhood onset type-1 diabetic patients. Nephrol Dial Transplant 2001;16:1382-6.

상세보기
Perkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS. Regression of microalbuminuria in type 1 diabetes. N Engl J Med 2003,348:2285-93.

상세보기
Tabaei BP, Al-Kassab AS, Ilag LL, Zawacki CM, Herman WH. Does microalbuminuria predict diabetic nephropathy? Diabetes Care 2001;24:1560-6.

상세보기
Giorgino F, Laviola L, Cavallo Perin P, Solnica B, Fuller J, Chaturvedi N. Factors associated with progression to macroalbuminuria in microalbuminuric type 1 diabetic patients: the EURODIAB Prospective Complications Study. Diabetologia 2004;47:1020-8.

상세보기
Peterson JC, Adler S, Burkart JM, Greene T, Hebert LA, Hunsicker LG, et al. Blood pressure control, proteinuria, and the progression of renal disease: The modification of Diet in Renal Disease study. Ann Intern Med 1995;123:754-62.

상세보기
Rossing P, Hougaard P, Borch-Jonhsen K, Parving HH. Predictors of mortality in insulin dependent diabetes : 10 year observational follow up study. BMJ 1996;313:779-84.

상세보기
Borch-Johnsen K, Anderson PK, Deckert T. The effect of proteinuria on relative mortality in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1985;28:590-6.

상세보기
Eppens MC, Craig ME, Cusumano J, Hing S, Chan AK, Howard NJ, et al. Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes. Diabetes Care 2006;29:1300-6.

상세보기
Yokoyama H, Okudaira M, Otani T, Sato A, Miura J, Takaike H, et al. Higher incidence of diabetic nephropathy in type 2 than in type 1 diabetes in early-onset diabetes in Japan. Kidney Int 2000;58:302-11.

상세보기
Parving HH, Chaturvedi N, Viberti G, Mogensen CE. Does microalbuminuria predict diabetic nephropathy? Diabetes Care 2002;25:406-7.

상세보기
Mortensen HB, Marinelli K, Norgaard K, Main K, Kastrup KW, Ibsen KK, et al. A nationwide crosssectional study of urinary albumin excretion rate, arterial blood pressure and blood glucose control in Danish children with type 1 diabetes mellitus. Danish Study Group on Diabetes in Childhood. Diabet Med 1990;7:887-97.

상세보기
Norgaard K, Feldt-Rasmussen BF, Borch-John-sen K, Saelan H, Deckert T. Prevalence of hypertension in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1990;33:407-10.

상세보기
Christensen PK, Rossing P, Nielsen FS, Parving HH. Natural course of kidney function in type 2 diabetic patients with diabetic nephropathy. Diabet Med 1999;16:388-94.

상세보기
Keller CK, Bergis KH, Fliser D, Ritz E. Renal findings in patients with short-term type 2 diabetes. J Am Soc Nephrol 1996;7:2627-35.

상세보기
Mogensen CE. Long-term antihypertensive treatment inhibiting pregression of diabetic nephropathy. Br Med J 1982;285:685-8.

상세보기
Parving HH, Anderson AR, Smidt UM, Svendsen PA. Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy. Lancet 1983;1:1175-9.
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ 1998;317:703-13.

상세보기
Jung H, Song YS, Chung H, Kim M, Park J, Shin GT, et al. Progression of diabetic nephropathy in type 1 diabetes in Korea. Korean J Nephrol 2005;24:873-83.
Cases A, Coll E. Dyslipidemia and the progression of renal disease in chronic renal failure patients. Kidney Int 2005;(Suppl 99):S87-93.
Wadwa RP, Kinney GL, Maahs DM, Snell-Bergeon JK, Hokanson JE, Garg SK, et al. Awareness and treatment of dyslipidemia in young adults with type 1 mdiabetes. Diabetes Care 2005;28:1051-6.

상세보기
Thomas MC, Rosengard-Barlund M, Mills V, Rnnback M, Thomas S, Forsblom C, et al. Serum lipids and the progression of nephropathy in type 1 diabetes. Diabetes Care 2006;29:317-22.

상세보기
Hussain T, Bagnall A, Agwu JC. NICE guidelines for hyperlipidamia in children and young people with type 1 diabetes: time for a rethink? Arch Dis Child 2006;91:545.

상세보기
Jenkins AJ. Lyons TJ, Zheng D, Otovous JD, Lackland DT, McGee D, Garvey WT, Klein BL, DCCT/EDIC Research Group. Lipoproteins in the DCCT/EDIC cohort: Associations with diabetic nephropathy. Kidney Int 2003;64:817-28.

상세보기
Tonolo G, Ciccarese M, Brizzi P, Puddu L, Secchi G, Calvia P, et al. Reduction of albumin excretion rate in normotensive microalbuminuric type 2 diabetic patients during longterm simvastatin treatment. Diabetes Care 1997;20:1891-5.

상세보기
Rich SS. Genetics of diabetes and its complications. J Am Soc Nephrol 2006;17:353-60.

상세보기
Rippin JD, Patel A, Bain SC. Genetics of diabetic nephropathy. Best Pract Res Clin Endocrinol Metab 2001;15:345-58.

상세보기
Seaquist ER, Goetz FC, Rich S, Barbosa J. Familial clustering of diabetic kidney disease. Evidence for genetic susceptibility to diabetic nephropathy. N Engl J Med 1989;320:1161-5.

상세보기
Quinn M, Angelico MC, Warram JH, Krolewski AS. Familial factors determine the development of diabetic nephropathy in patients with IDDM. Diabetologia 1996;39:940-5.

상세보기
Fujisawa T, Ikegami H, Kawaguchi Y, Hamada Y, Vesta H, Shintani M, et al. Meta-analysis of association of insertion/deletion polymorphism of angiotensin I-converting enzyme gene with diabetic nephropathy and retinopathy. Diabetologia 1998;41:47-53.

상세보기
Hadjadj S, Belloum R, Bouhanick B Gallois Y, Guilloteau G, Chatellier G, et al. Prognostic value of angiotensin-I converting enzyme I/D polymorphism for nephropathy in type I diabetes mellitus: a prospective study. J Am Soc Nephrol 2001;12:541-9.

상세보기
Solini A, Dalla Vestra M, Saller A, Nosadini R, Crepaldi G, et al. The angiotensin-converting enzyme DD genotype is associated with glomerulopathy lesions in type 2 diabetes. Diabetes 2002;51:251-5.

상세보기

저자의 다른 논문 :

LOADING...

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증