Details are less clear in patients with type 2 diabetes, but the natural history of diabetic nephropathy in type 1 diabetes is well described.
2型糖尿病病人（腎病)的細(xì)節(jié)不是很清楚，但1型糖尿病腎病的自然病程已有充分的描述。
The period immediately following diagnosis is best characterized by glomerular hyperfiltration.
(glomerular 腎小球的 hyperfiltration 超過濾)
緊接診斷后的一段時(shí)期以腎小球超過濾最具有特征。
During this time, there is renal hypertrophy, increased renal blood flow, increased glomerular volume, and an increased transglomerular pressure gradient, all contributing to a rise in GFR.
(hypertrophy 肥大 gradient 坡度、梯度 GFR glomerular filtration rate 腎小球?yàn)V率)
在這段時(shí)間中，有腎臟肥大、腎血流增加、腎小球容積增大和經(jīng)腎小球的壓力梯度增加，這些都與腎小球?yàn)V過率增加有關(guān)。
Importantly, these changes depend at least in part on hyperglycemia, as they are diminished by intensive diabetes treatment. (hyperglycemia 高血糖 intensive 加強(qiáng)的，密集的)
重要的是，這些變化至少是部分依靠高血糖，因?yàn)橥ㄟ^有力的糖尿病治療它們會消失。
Three to 5 years after diagnosis, early glomerular lesions appear, characterized by thickening of glomerular basement membranes, mesangial matrix expansion, and arteriolosclerosis.
mesangial 腎小球系膜的 matrix 母體、基礎(chǔ)
診斷后的3~5年，早期的腎小球損害出現(xiàn)，以腎小球基底膜增厚、系膜基底擴(kuò)張和小動脈硬化為特征。
Albumin excretion remains low during early glomerular changes; however, as pathologic changes mount, the glomeruli lise their functional integrity, resulting in glomerlar filtration defects and increased glomerular permeability.
Albumin 白蛋白 mount 騎上、進(jìn)行攻擊 integrity 完整、完善
defect 缺點(diǎn)、缺陷 permeability 滲透性
Albumin excretion remains low during early glomerular changes; however, as pathologic changes mount, the glomeruli lose their functional integrity, resulting in glomerlar filtration defects and increased glomerular permeability.
在腎小球變化早期白蛋白排泄仍然較低，但是，病理變化進(jìn)行著，腎小球失去完善的功能，引起腎小球?yàn)V過的缺陷，腎小球滲透性增加。
Although results of routine tests of renal function (creatinine and urinalysis) still remain normal, microalbuminuria (30 to 300 mg/day) appears.
盡管腎功能的常規(guī)化驗(yàn)（肌酐和尿檢)結(jié)果還是正常，但微白蛋白尿（30~300毫克／天)已經(jīng)出現(xiàn)。
Systemic hypertension is also present at this time in more than 50% of cases.
在這個(gè)時(shí)期，50%以上的病例還出現(xiàn)全身高血壓。
After several years, most diabetic patients exhibit diffuse glomerulosclerosis, although a minority have pathognomonic Kimmelsteil-wilson nodular throughout lesions .
exhibit 展示、陳列 diffuse 擴(kuò)散、傳播 glomerulosclerosis 腎小球硬化癥
pathognomonic 特異病征性的
數(shù)年以后，大多數(shù)糖尿病病人顯示不斷擴(kuò)展的腎小球硬化，盡管只有少數(shù)病人有特異性的Kimmelsteil-wilson小結(jié)。
Although pathologic changes continue to mount throughout the disease, glomerulosclerosis extensive enough to cause ESRD develops in a minority of patients; in these cases, overt albuminuria (>300 mg/day) begins approximatedly 15 years after diagnosis.
overt 明顯的、公然的
盡管病理變化在整個(gè)病程中是持續(xù)發(fā)展的，只有少數(shù)病人的腎小球硬化范圍大到足以引起晚期腎病，這些病例中，明顯的白蛋白尿（>300mg/天)大約在診斷后15年開始。
Soon after, following a variable period on the order of 3 to 5 years, the GFR begins a relentless decline (≥10 ml/min/year), which is eventually reflected by an increase in serum creatinine.
on the order of 屬于…一類的、與…相似的 relentless 殘忍的、不留情面的
之后，接著一個(gè)易變的時(shí)期，約需3~5年，腎小球?yàn)V過率開始極度下降（≥10毫升/天/年)，最終以血清肌酐濃度增高表現(xiàn)出來。
The appearance of massive proteinuria and the nephrotic syndrome is common in this context and often heralds progression to ESRD.
nephrotic syndrome 腎病綜合癥 context 環(huán)境、背境、上下文
herald 傳令、預(yù)示、預(yù)報(bào) progression 進(jìn)行、前進(jìn)、進(jìn)展
在這樣的情況下，大量蛋白尿和腎病綜合癥的出現(xiàn)是常見的，常預(yù)示晚期腎病的進(jìn)展。
Once the serum creatinine rises (reflecting an approximately 50% decline in GFR), ESRD develops in most patients within 10 years.
potentially 潛在的、可能的 inaccessible 達(dá)不到的、難接近的
一旦血清肌酐濃度增高（反映腎小球?yàn)V過率約下降50%)，多數(shù)病人10年內(nèi)發(fā)展成晚期腎病。
This course is highly variable, houever, particularly in type 2 diabetics, who may exhibit moderate proteinuria for several years without a substantial deterioration of renal function.
deterioration 變化、退化、惡化
但是，這個(gè)過程是非常易變的，特別是2型糖尿病，可以出現(xiàn)許多年的中等蛋白尿而不發(fā)生實(shí)質(zhì)性的腎功能惡化。
A simple but useful method of monitoring progression to renal failure is to plot the reciprocal of the seum creatinine as a function of time.
plot 小塊地皮、地基、用圖標(biāo)出、陰謀 reciprocal 相互的、倒數(shù)、互補(bǔ)
一個(gè)簡單而實(shí)用的腎功能衰竭進(jìn)展的監(jiān)測方法是用圖表記錄血清肌酐的倒數(shù)作為當(dāng)時(shí)的腎功能。
This technique allows better assesssment of both therapeutic interventions and the time when renal replacement therapy will become necessary.
potentially 潛在的、可能的 inaccessible 達(dá)不到的、難接近的
這個(gè)技術(shù)使治療性干預(yù)和腎移植時(shí)間的評價(jià)更為完善。
Chapter 26 Trauma in Pregnancy Page 78第二十六章 孕期創(chuàng)傷 第78頁
Trauma is the leading nonobstetric cause of maternal mortality and occurs in as many as 7% of pregnancies. (maternal 母親的、母性的 mortality 死亡數(shù)、死亡率)
創(chuàng)傷是產(chǎn)婦死亡首要的非產(chǎn)科因素，在孕婦中多達(dá)7%。
The most common mechanisms of injury are from falls or from motor vehicle crashes.
(mechanism 機(jī)械、結(jié)構(gòu)、機(jī)制 vehicle 運(yùn)載工具、車輛)
最常見的損傷機(jī)制是跌倒或機(jī)動車碰撞。
When compared to age-matched pregnant controls, pregnant women who sustained trauma had a higher incidence of spontaneous abortion, preterm labor , fetomaternal hemorrhage, abruptio placentae, and uterine rupture. (match 與……相配、使成對 ssustain 遭受、承受)
同孕齡配對的對照試驗(yàn)中，遭受創(chuàng)傷的孕婦更易發(fā)生自然流產(chǎn)、早產(chǎn)、母嬰出血，胎盤早剝和子宮破裂。
As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment. (agree on 對……取得一致意見 sphygmomanometer 血壓計(jì))
因?yàn)閮?nèi)鏡是后退的，內(nèi)鏡發(fā)現(xiàn)可以為外科決定切除或（保守)治療。
The yield of this procedure exceeds 70%. 這個(gè)措施的結(jié)果超過70%。
In some clinical situations, the site of bleelding cannot be identified, and the patient requires long-term transfusion therapy. (long-term 長期的 transfusion 輸血)
某些臨床情況下，出血部位無法發(fā)現(xiàn)，病人而要長期的輸血治療。
Multiple studies have attempted to identify risk factors that predict morbidity and mortality in the pregnant trauma patient.
multiple 多種因素組成的、復(fù)合的、多樣的 predict 預(yù)計(jì)，預(yù)測
許多組合研究試圖確定能預(yù)示創(chuàng)傷孕婦發(fā)病和死亡的風(fēng)險(xiǎn)因素。
The maternal Injury Severity Score, mechanism of injury, and physical findings are unable to adequately predict adverse outcomes such as abruptio placentae and fetal loss.
adverse 相反的、不利的
母親的創(chuàng)傷指數(shù)、損傷機(jī)制、體檢發(fā)現(xiàn)都不能恰當(dāng)?shù)仡A(yù)示如子宮破裂、妊娠中止等不利結(jié)局。
Early involvement of an available obstetrician is important to evaluate both maternal and fetal well-being.
(involvement 連累、纏繞 available 可用的、可聯(lián)系的 well-being 康樂、安康、福利)
聯(lián)系緊密的產(chǎn)科醫(yī)生早期介入，檢查評估母嬰雙方健康狀況是非常重要的。
