diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12944diaendo-12944Research ArticleОбзорыReviewХроническая болезнь почек у пациентов с сахарным диабетом 2 типа: новые мишени лекарственного воздействияChronic kidney disease in patients with type 2 diabetes: new targets of medicine actionhttps://orcid.org/0000-0003-3838-8285ТрубицынаН. П.TrubitsynaN. P.

Трубицына Наталья Петровна - кандидат медицинских наук, ведущий научный сотрудник.

117036, Москва, ул. Дм. Ульянова, д. 11

Natalia P. Trubitsyna - MD, PhD, leading research associate.

11, Dm. Ul’yanova st., Moscow, 117036

trubicina@mail.ruhttps://orcid.org/0000-0001-9235-5594ЗайцеваН. В.ZaitsevaN. V.

Зайцева Наталья Владиславовна - кандидат медицинских наук, ведущий научный сотрудник; eLibrary SPIN: 8894-8815.

Москва

Natalia V. Zaitseva - MD, PhD, leading research associate; eLibrary SPIN: 8894-8815.

Moscow

nata.zaec@gmail.comhttps://orcid.org/0000-0002-0296-4933СеверинаА. С.SeverinаA. S.

Северина Анастасия Сергеевна - кандидат медицинских наук, ведущий научный сотрудник; eLibrary SPIN: 3182-9510.

Москва

Anastasia S. Severina - MD, PhD, leading research associate; eLibrary SPIN: 3182-9510.

Moscow

ansev1@mail.ruhttps://orcid.org/0000-0002-3433-0142ШамхаловаМ. Ш.ShamkhalovaM. S.

Шамхалова Минара Шамхаловна - доктор медицинских наук; eLibrary SPIN: 4942-5481.

Москва

Minara S. Shamhalova - MD, PhD; eLibrary SPIN: 4942-5481.

Moscow

shamkhalova@mail.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation202230112022255492498Copyright © Трубицына Н.П., Зайцева Н.В., Северина А.С., Шамхалова М.Ш., 20222022Трубицына Н.П., Зайцева Н.В., Северина А.С., Шамхалова М.Ш.Trubitsyna N.P., Zaitseva N.V., Severinа A.S., Shamkhalova M.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12944

Сахарный диабет 2 типа (СД2) — социально значимое заболевание, которое по темпу роста распространенности приобретает характер неинфекционной эпидемии. Хроническая болезнь почек (ХБП) является одним из наиболее частых осложнений СД2. Признаки повреждения почек и/или снижение скорости клубочковой фильтрации (СКФ) выявляют у 40–50% пациентов с СД2. Считается, что в основе развития и прогрессирования ХБП на фоне СД2 лежат три группы факторов: метаболические, гемодинамические, а также факторы воспаления и фиброза. Препараты, применяемые в настоящее время у пациентов с ХБП и СД2, в первую очередь направлены на коррекцию гемодинамических и метаболических нарушений, а на процессы воспаления и фиброза воздействуют лишь косвенно. Гиперактивация минералокортикоидных рецепторов (МКР) рассматривается в качестве одного из основных пусковых механизмов повреждения органов-мишеней у пациентов с СД2 за счет потенцирования воспаления и фиброза. Разработка и изучение препаратов из нового класса селективных нестероидных антагонистов МКР (АМКР) направлены на получение доказательств положительных эффектов от блокирования данного патофизиологического пути развития ХБП и преодоление недостатков, характерных для стероидных АМКР. Таким образом, патологическая гипер­активация МКР с развитием воспаления и фиброза у пациентов с ХБП на фоне СД2 представляется перспективной терапевтической мишенью для реализации таргетной кардионефропротективной терапии новыми лекарственными препаратами.

Diabetes mellitus type 2 (DM2) is socially important disease, becoming non-infectious epidemic due to increasing prevalence. Chronic kidney disease (CKD) is one of the most common diabetic complications. Kidney injury signs and/or estimated glomerular filtration rate (eGFR) decrease are seen in 40-50% of patients with DM2. Three groups of factors are considered to be the basis of CKD development and progression in DM2: metabolic, hemodynamic, inflammation and fibrosis. Existing drugs that are used in patients with CKD and DM2 first of all target hemodynamic and metabolic disturbances, but their action against inflammation and fibrosis is indirect. Hyperactivation of mineralocorticoid receptors (MR) is considered as one of the main trigger factors of end-organ damage in patients with DM2 due to inflammation and fibrosis. Development of selective nonsteroidal MR antagonists (MRA) as a new class of medications is directed to demonstrate positive effects from blocking this pathophysiological pathway of CKD development and overcome the steroidal MRAs’ shortcomings. Hence pathophysiological hyperactivation of MR with subsequent inflammation and fibrosis in patients with CKD in DM2 is considered a promising therapeutic target for the new drugs with cardionephroprotective effect.

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The authors declare that there are no conflicts of interest present.