Bệnh nhân đái bệnh tiểu đường loại 2 làm tăng nguy cơ cho sự phát triển của suy thận. Nguy cơ của bệnh thận mạnh mẽ là do di truyền, và phân nhóm gia đình thường gặp ở bệnh nhân tiểu đường. | XII. Endocrine and Metabolic Disorders Answers 319 XII-62. The answer is E. Chap. 333. Rits Orth N Engl J Med 341 1127-1133 1999. Patients with type 2 diabetes mellitus are at an increased risk for the development of renal failure. The risk of nephropathy is strongly determined by genetics and familial clustering is typically seen in diabetic patients. Factors that increase the risk of progression to endstage renal failure include hypertension albuminuria poor glycemic control smoking high dietary intake of protein and hyperlipidemia. Once nephropathy is developed patients can decrease the risk of progression by achieving better glycemic control and maintaining better control of their blood pressure. In addition cessation of smoking as well as the restriction of dietary protein are also thought to be helpful. Patients with diabetes who have microalbuminuria have not yet begun to lose glomerular filtration but are at a high risk for the development of renal complications. Microalbuminuria is defined as a urinary albumin excretion rate of 30 to 300 mg per 24 h on two of three measurements. The test results cannot be interpreted correctly in the presence of a urinary tract infection fever uncontrolled hyperglycemia or hypertension or in the presence of congestive heart failure. Patients with diabetes who have microalbuminuria also have an extremely high risk for the development of cardiovascular complications. A 1995 consensus statement recommended antihypertensive treatment preferably with ACE inhibitors be started once microalbuminuria has been documented. XII-63. The answer is E. Chap. 328 Because the half-life of T4 is 1 week the total T4 will still be normal the day after the pituitary ceases to function. T3 is derived primarily from T4 and so it will still also be normal. IGF-I is a useful test for detecting growth hormone excess as occurs in acromegaly but it is not a sensitive test of growth hormone deficiency. In addition IGF-I would not fall rapidly to a new
