Podocyte loss and progressive glomerular injury in type II diabetes
Podocyte loss and progressive glomerular injury in type II diabetes
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DOI：
10.1172/jci119163
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发表时间：
1997-01-15
影响因子：
15.9
通讯作者：
Meyer, TW
中科院分区：
文献类型：
--
作者：
Pagtalunan, ME;Miller, PL;Meyer, TW
对患有II型糖尿病的皮马印第安人的肾脏活检进行了分析。受试者的临床分类为早期糖尿病(n=10)、微量白蛋白尿(n=17)、正常白蛋白尿，尽管糖尿病病程与有微量白蛋白尿的受试者(n=12)或临床肾病(n=12)相同。与早期糖尿病患者相比，微量白蛋白尿组的肾小球和肾小球系膜体积有适度增加，但与同等病程糖尿病后仍保持正常白蛋白尿的受试者不能区分。临床肾病的受试者表现为肾小球硬化，非硬化肾小球结构异常更为突出。显著的系膜扩张伴随着肾小球体积的进一步增加。肾小球毛细血管表面积保持稳定，但肾小球基底膜增厚，足细胞足突增宽。足细胞足突的扩大与每个肾小球的足细胞数量减少和剩余足细胞覆盖的表面积增加有关。这些发现表明足细胞丢失有助于糖尿病肾病的进展。
Kidney biopsies from Pima Indians with type II diabetes were analyzed. Subjects were classified clinically as having early diabetes (n = 10), microalbuminuria (n = 17), normoalbuminuria, despite a duration of diabetes equal to that of the subjects with microalbuminuria (n = 12), or clinical nephropathy (n = 12). Subjects with microalbuminuria exhibited moderate increases in glomerular and mesangial volume when compared with those with early diabetes, but could not be distinguished from subjects who remained normoalbuminuric after an equal duration of diabetes. Subjects with clinical nephropathy exhibited global glomerular sclerosis and more prominent structural abnormalities in non-sclerosed glomeruli. Marked mesangial expansion was accompanied by a further increase in total glomerular volume. Glomerular capillary surface area remained stable, but the glomerular basement membrane thickness was increased and podocyte foot processes were broadened. Broadening of podocyte foot processes was associated with a reduction in the number of podocytes per glomerulus and an increase in the surface area covered by remaining podocytes. These findings suggest that podocyte loss contributes to the progression of diabetic nephropathy.