Causes of albuminuria in patients with type 2 diabetes without diabetic retinopathy
Causes of albuminuria in patients with type 2 diabetes without diabetic retinopathy
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DOI：
10.1046/j.1523-1755.2000.00333.x
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发表时间：
2000-10-01
影响因子：
19.6
通讯作者：
Parving, HH
中科院分区：
文献类型：
--
作者：
Christensen, PK;Larsen, S;Parving, HH
背景2型糖尿病患者白蛋白尿的原因是异质性的，很少调查，特别是如果患者没有糖尿病视网膜病变。因此，我们评估了一个大的连续组的白人2型糖尿病患者无视网膜病变的蛋白尿的结构背景。记录了347例持续性白蛋白尿（>300 mg/ 24 h）的2型糖尿病患者。眼底照相（80%）和眼底镜检查。93例（27%）无视网膜病变，其中52例（56%）进行了肾活检。在1例患者中获得的组织样本不足。由三位不知情的肾脏病理学家对活检进行评价。活检显示69%的患者（28名男性和7名女性）患有糖尿病性肾小球病，而其余31%（95% CI，18 - 44）患有非糖尿病性肾小球病，如肾小球肾炎（N = 7，6名男性和1名女性，13%）或正常肾小球结构（N = 9，7名男性和2名女性，18%）。性别、年龄无显著差异（56 +/- 8 vs. 53 +/- 10岁，平均SD），体重指数（30 +/- 4 vs. 31 +/- 8 kg/m2），已知糖尿病持续时间（6 +/- 6 vs. 4 +/- 3岁），GFR（95 +/- 29 vs. 89 +/- 31 mL/min/1.73 m（2）），蛋白尿（1304 +/- 169至4731与1050 +/- 181至5176 mg/24小时），血压（150/87 +/- 16/9 vs. 145/89 +/- 16/9 mm Hg），高血压患病率（89%对100%）、血红蛋白A（1c）（8.2 +/- 1.6%对9.0 +/- 2.5%）和血清总胆固醇（7.1 +/- 2.4对6.3 +/- 1.6 mmol/L）。无糖尿病视网膜病变的2型糖尿病白蛋白尿患者活检肾小球结构正常或非糖尿病肾病的患病率约为30%。根据人口统计学、临床或实验室数据，不可能将糖尿病和非糖尿病肾小球病变分开。因此，这些患者可能需要进一步评估，包括肾活检。
Background. The causes of albuminuria in patients with type 2 diabetes are heterogeneous and are scantily investigated, particularly if the patient has a lack of diabetic retinopathy. Therefore, we evaluated the structural background of albuminuria in a large consecutive group of Caucasian patients with type 2 diabetes without retinopathy.Methods. Three hundred forty-seven consecutive patients with type 2 diabetes with persistent albuminuria (>300 mg/ 24 h) were recorded. Fundus photo (80%) and ophthalmoscopy were performed. Ninety-three (27%) had no retinopathy, and a kidney biopsy was performed in 52 (56%) of these patients. An insufficient tissue sample was obtained in one patient. The biopsies were evaluated by three masked nephropathologists.Results. The biopsies revealed diabetic glomerulopathy in 69% of the patients (28 males and 7 females), while the remaining 31% (95% CI, 18 to 44) had either nondiabetic glomerulopathies such as glomerulonephritis (N = 7, 6 males and 1 female, 13%) or normal glomerular structure (N = 9, 7 males and 2 females, 18%). No significant differences in sex, age (56 +/- 8 vs. 53 +/- 10 years, mean SD), body mass index (30 +/- 4 vs. 31 +/- 8 kg/m(2)), known duration of diabetes (6 +/- 6 vs. 4 +/- 3 years), GFR (95 +/- 29 vs. 89 +/- 31 mL/min/1.73 m(2)), albuminuria (1304 +/- 169 to 4731 vs. 1050 +/- 181 to 5176 mg/24 hours), blood pressure (150/87 +/- 16/9 vs. 145/89 +/- 16/9 mm Hg), prevalence of hypertension (89 vs. 100%), hemoglobin A(1c) (8.2 +/- 1.6% vs. 9.0 +/- 2.5%), and serum total cholesterol (7.1 +/- 2.4 vs. 6.3 +/- 1.6 mmol/L) were found between patients with and without diabetic glomerulopathy.Conclusions. Albuminuric patients with type 2 diabetes without diabetic retinopathy have a prevalence of biopsies with normal glomerular structure or nondiabetic kidney diseases of approximately 30%. A separation between diabetic and nondiabetic glomerular lesions was not possible based on demographic, clinical, or laboratory data. Consequently, such patients may require further evaluation, including a kidney biopsy.