Reversal of lesions of diabetic nephropathy after pancreas transplantation.
Reversal of lesions of diabetic nephropathy after pancreas transplantation.
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DOI：
10.1097/00132586-199902000-00065
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发表时间：
1998-07
期刊：
影响因子：
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通讯作者：
P. Fioretto;M. Steffes;D. Sutherland;F. Goetz;M. Mauer
中科院分区：
文献类型：
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作者：
P. Fioretto;M. Steffes;D. Sutherland;F. Goetz;M. Mauer
背景：对于没有尿毒症且没有接受过肾移植的I型糖尿病患者，胰腺移植在移植后5年内并不能改善糖尿病肾病的病变，但较长时间的正常血糖的影响尚不清楚。方法研究了8例1型糖尿病患者在胰腺移植前和移植后5年和10年的肾功能和肾活检，这些患者在移植时有轻度到晚期糖尿病肾病病变，但没有尿毒症。活检样本进行形态计量学分析。结果所有患者移植后糖化血红蛋白持续正常。尿白蛋白排泄率中位数为移植前103 mg / d，移植后5年30 mg / d，移植后10年20 mg / d（基线与5年比较P=0.07；基线与10年比较P=0.11）。平均（+/-SD）肌酐清除率从基线时每1.73 m2体表面积108+/-20 ml /分钟下降到5年时每1.73 m2 74+/-16 ml /分钟（P<0.001）和10年时每1.73 m2 74+/-14 ml /分钟（P<0.001）。肾小球和肾小管基底膜的厚度在5年时（分别为570+/-64和928+/-173 nm）和基线时（分别为594+/-81和911+/-133 nm）相似，但在10年时有所下降（分别为404+/-38和690+/-111 nm；与基线值比较，P<0.001和P=0.004）。系膜分数体积（肾小球被系膜占据的比例）从基线（0.33+/-0.07）到5年（0.39+/-0.10，P=0.02）增加，但在10年（0.27+/-0.02，与基线值比较P=0.05，与5年比较P=0.006）下降，主要是因为系膜基质减少。结论胰腺移植可以逆转糖尿病肾病病变，但逆转需要5年以上血糖正常。
BACKGROUND In patients with type I diabetes mellitus who do not have uremia and have not received a kidney transplant, pancreas transplantation does not ameliorate established lesions of diabetic nephropathy within five years after transplantation, but the effects of longer periods of normoglycemia are unknown. METHODS We studied kidney function and performed renal biopsies before pancreas transplantation and 5 and 10 years thereafter in eight patients with type I diabetes but without uremia who had mild to advanced lesions of diabetic nephropathy at the time of transplantation. The biopsy samples were analyzed morphometrically. RESULTS All patients had persistently normal glycosylated hemoglobin values after transplantation. The median urinary albumin excretion rate was 103 mg per day before transplantation, 30 mg per day 5 years after transplantation, and 20 mg per day 10 years after transplantation (P=0.07 for the comparison of values at base line and at 5 years; P=0.11 for the comparison between base line and 10 years). The mean (+/-SD) creatinine clearance rate declined from 108+/-20 ml per minute per 1.73 m2 of body-surface area at base line to 74+/-16 ml per minute per 1.73 m2 at 5 years (P<0.001) and 74+/-14 ml per minute per 1.73 m2 at 10 years (P<0.001). The thickness of the glomerular and tubular basement membranes was similar at 5 years (570+/-64 and 928+/-173 nm, respectively) and at base line (594+/-81 and 911+/-133 nm, respectively) but had decreased by 10 years (to 404+/-38 and 690+/-111 nm, respectively; P<0.001 and P=0.004 for the comparisons with the base-line values). The mesangial fractional volume (the proportion of the glomerulus occupied by the mesangium) increased from base line (0.33+/-0.07) to 5 years (0.39+/-0.10, P=0.02) but had decreased at 10 years (0.27+/-0.02, P=0.05 for the comparison with the baseline value and P=0.006 for the comparison with the value at 5 years), mostly because of a reduction in mesangial matrix. CONCLUSIONS Pancreas transplantation can reverse the lesions of diabetic nephropathy, but reversal requires more than five years of normoglycemia.