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（肾病)的细节不是很清楚，但1型糖尿病肾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 肾小球的 hyperfiltration 超过滤)
紧接诊断后的一段时期以肾小球超过滤最具有特征。
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 肾小球滤率)
在这段时间中，有肾脏肥大、肾血流增加、肾小球容积增大和经肾小球的压力梯度增加，这些都与肾小球滤过率增加有关。
Importantly, these changes depend at least in part on hyperglycemia, as they are diminished by intensive diabetes treatment. (hyperglycemia 高血糖 intensive 加强的，密集的)
重要的是，这些变化至少是部分依靠高血糖，因为通过有力的糖尿病治疗它们会消失。
Three to 5 years after diagnosis, early glomerular lesions appear, characterized by thickening of glomerular basement membranes, mesangial matrix expansion, and arteriolosclerosis.
mesangial 肾小球系膜的 matrix 母体、基础
诊断后的3~5年，早期的肾小球损害出现，以肾小球基底膜增厚、系膜基底扩张和小动脉硬化为特征。
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 骑上、进行攻击 integrity 完整、完善
defect 缺点、缺陷 permeability 渗透性
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.
在肾小球变化早期白蛋白排泄仍然较低，但是，病理变化进行着，肾小球失去完善的功能，引起肾小球滤过的缺陷，肾小球渗透性增加。
Although results of routine tests of renal function (creatinine and urinalysis) still remain normal, microalbuminuria (30 to 300 mg/day) appears.
尽管肾功能的常规化验（肌酐和尿检)结果还是正常，但微白蛋白尿（30~300毫克／天)已经出现。
Systemic hypertension is also present at this time in more than 50% of cases.
在这个时期，50%以上的病例还出现全身高血压。
After several years, most diabetic patients exhibit diffuse glomerulosclerosis, although a minority have pathognomonic Kimmelsteil-wilson nodular throughout lesions .
exhibit 展示、陈列 diffuse 扩散、传播 glomerulosclerosis 肾小球硬化症
pathognomonic 特异病征性的
数年以后，大多数糖尿病病人显示不断扩展的肾小球硬化，尽管只有少数病人有特异性的Kimmelsteil-wilson小结。
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 明显的、公然的
尽管病理变化在整个病程中是持续发展的，只有少数病人的肾小球硬化范围大到足以引起晚期肾病，这些病例中，明显的白蛋白尿（>300mg/天)大约在诊断后15年开始。
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 属于…一类的、与…相似的 relentless 残忍的、不留情面的
之后，接着一个易变的时期，约需3~5年，肾小球滤过率开始极度下降（≥10毫升/天/年)，最终以血清肌酐浓度增高表现出来。
The appearance of massive proteinuria and the nephrotic syndrome is common in this context and often heralds progression to ESRD.
nephrotic syndrome 肾病综合症 context 环境、背境、上下文
herald 传令、预示、预报 progression 进行、前进、进展
在这样的情况下，大量蛋白尿和肾病综合症的出现是常见的，常预示晚期肾病的进展。
Once the serum creatinine rises (reflecting an approximately 50% decline in GFR), ESRD develops in most patients within 10 years.
potentially 潜在的、可能的 inaccessible 达不到的、难接近的
一旦血清肌酐浓度增高（反映肾小球滤过率约下降50%)，多数病人10年内发展成晚期肾病。
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 变化、退化、恶化
但是，这个过程是非常易变的，特别是2型糖尿病，可以出现许多年的中等蛋白尿而不发生实质性的肾功能恶化。
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 小块地皮、地基、用图标出、阴谋 reciprocal 相互的、倒数、互补
一个简单而实用的肾功能衰竭进展的监测方法是用图表记录血清肌酐的倒数作为当时的肾功能。
This technique allows better assesssment of both therapeutic interventions and the time when renal replacement therapy will become necessary.
potentially 潜在的、可能的 inaccessible 达不到的、难接近的
这个技术使治疗性干预和肾移植时间的评价更为完善。
Chapter 26 Trauma in Pregnancy Page 78第二十六章 孕期创伤 第78页
Trauma is the leading nonobstetric cause of maternal mortality and occurs in as many as 7% of pregnancies. (maternal 母亲的、母性的 mortality 死亡数、死亡率)
创伤是产妇死亡首要的非产科因素，在孕妇中多达7%。
The most common mechanisms of injury are from falls or from motor vehicle crashes.
(mechanism 机械、结构、机制 vehicle 运载工具、车辆)
最常见的损伤机制是跌倒或机动车碰撞。
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 与……相配、使成对 ssustain 遭受、承受)
同孕龄配对的对照试验中，遭受创伤的孕妇更易发生自然流产、早产、母婴出血，胎盘早剥和子宫破裂。
As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment. (agree on 对……取得一致意见 sphygmomanometer 血压计)
因为内镜是后退的，内镜发现可以为外科决定切除或（保守)治疗。
The yield of this procedure exceeds 70%. 这个措施的结果超过70%。
In some clinical situations, the site of bleelding cannot be identified, and the patient requires long-term transfusion therapy. (long-term 长期的 transfusion 输血)
某些临床情况下，出血部位无法发现，病人而要长期的输血治疗。
Multiple studies have attempted to identify risk factors that predict morbidity and mortality in the pregnant trauma patient.
multiple 多种因素组成的、复合的、多样的 predict 预计，预测
许多组合研究试图确定能预示创伤孕妇发病和死亡的风险因素。
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
母亲的创伤指数、损伤机制、体检发现都不能恰当地预示如子宫破裂、妊娠中止等不利结局。
Early involvement of an available obstetrician is important to evaluate both maternal and fetal well-being.
(involvement 连累、缠绕 available 可用的、可联系的 well-being 康乐、安康、福利)
联系紧密的产科医生早期介入，检查评估母婴双方健康状况是非常重要的。
