Renal pathology patterns in type II diabetes mellitus: relationship with retinopathy
Renal pathology patterns in type II diabetes mellitus: relationship with retinopathy
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DOI：
10.1093/ndt/13.10.2547
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发表时间：
1998-10-01
影响因子：
6.1
通讯作者：
Batlle, D
中科院分区：
文献类型：
--
作者：
Schwartz, MM;Lewis, EJ;Batlle, D
背景I型和II型糖尿病患者的肾小球和视网膜血管均受到影响。然而，结节性糖尿病肾小球硬化（Kimmelstiel-Wilson病变）和其他形式的肾小球病理（包括弥漫性系膜硬化）的患病率及其在II型糖尿病中的临床相关性尚不为人所知。此外，尽管最近的研究表明，非糖尿病性肾小球疾病是II型糖尿病蛋白尿的常见原因，但其他疾病的患病率尚不清楚。关于这一主题的文献被糖尿病患者接受肾活检的临床偏倚所笼罩。肾小球和视网膜。对36例II型糖尿病、蛋白尿、肾功能不全和高血压患者进行前瞻性临床试验，研究其病理和临床相关性。17例活检有糖尿病性肾小球硬化伴Kimmelstiel-Wilson结节; 15例活检有糖尿病状态特征性肾小球变化，包括肾小球扩大和系膜基质增加，无Kimmelstiel-Wilson结节（系膜硬化病变）; 2例有其他原发性肾小球疾病（伊加和膜性肾病）。与系膜硬化病变患者相比，Kimmelstiel-Wilson结节患者血清肌酐升高，但没有其他显著差异。Kimmelstiel-Wilson结节患者的总体视网膜病变比系膜硬化病变患者更严重（P = 0.0043）。7例增殖性视网膜病变患者中有6例有Kimmelstiel-Wilson结节，8例无视网膜病变患者中有7例有系膜硬化病变。肾小球病理的两种离散模式以及糖尿病视网膜病变与Kimmelstiel-Wilson病变而非系膜硬化病变之间的相关性表明糖尿病肾小球硬化的Kimmelstiel-Wilson病变和系膜硬化病变由不同的发病机制引起。在这项研究中，糖尿病性肾小球硬化是94%的II型糖尿病患者临床肾脏异常的原因。
Background. The glomerular and retinal vessels are both affected in patients with type I and type II diabetes mellitus. However, the prevalence of the nodular form of diabetic glomerular sclerosis (Kimmelstiel-Wilson lesion) and other forms of glomerular pathology including diffuse mesangial sclerosis and their clinical correlates in type II diabetes are less well known. In addition, although recent studies have suggested that non-diabetic glomerular disease was a common cause of proteinuria in type II diabetes, the prevalence of other diseases is unknown. The literature on this subject is clouded by clinical bias regarding patients with diabetes who undergo renal biopsy.Methods. Glomerular and retinal. pathology and clinical correlates were studied in 36 patients enrolled in a prospective clinical trial of patients with type II diabetes mellitus, proteinuria, renal insufficiency, and hypertension.Results. Seventeen biopsies had diabetic glomerular sclerosis with Kimmelstiel-Wilson nodules; 15 biopsies had glomerular changes characteristic of the diabetic state including enlarged glomeruli and an increase in mesangial matrix without Kimmelstiel-Wilson nodules (mesangial sclerosis lesion); and two had other primary glomerular diseases (IgA and membranous nephropathy). Patients with Kimmelstiel-Wilson nodules had elevated serum creatinines compared to patients with mesangial sclerosis lesions, but there were no other significant differences. Patients with Kimmelstiel-Wilson nodules had more severe overall retinopathy than those with mesangial sclerosis lesions (P = 0.0043). six of seven with proliferative retinopathy had Kimmelstiel-Wilson nodules, and seven of the eight patients without retinopathy had mesangial sclerosis lesions.Conclusions. The two discrete patterns of glomerular pathology and the correlation between diabetic retinopathy and the Kimmelstiel-Wilson lesion but not the mesangial sclerosis lesion suggest that the Kimmelstiel-Wilson and mesangial sclerosis lesions of diabetic glomerulosclerosis are caused by different pathogenetic mechanisms. In this study, diabetic glomerulosclerosis was responsible for the clinical renal abnormalities in 94% of patients with type II diabetes mellitus.