GLOMERULAR-FILTRATION SURFACE IN TYPE-I DIABETES-MELLITUS
GLOMERULAR-FILTRATION SURFACE IN TYPE-I DIABETES-MELLITUS
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DOI：
10.1038/ki.1986.82
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发表时间：
1986-04-01
影响因子：
19.6
通讯作者：
MAUER, SM
中科院分区：
文献类型：
--
作者：
ELLIS, EN;STEFFES, MW;MAUER, SM
以前我们已经表明，肾小球系膜相对扩张是糖尿病肾功能不全的重要相关因素。为了扩展对结构功能关系的理解，对37例5 ~ 33年的I型糖尿病患者进行了多项肌酐清除率（CCr）、尿白蛋白排泄、血压测量和经皮肾活检研究。测定肾小球体积和硬化肾小球百分比;进行定量体视学以确定相对肾小球结构参数。我们计算每个肾小球的系膜体积和毛细血管滤过表面积，并估计每个患者的毛细血管滤过表面积。肾小球毛细血管滤过表面积与CCr有高度相关性（r =+0.78，r =+0.79，P = 0.001）。CCr与系膜体积之间存在显著但较弱的相关性。然而，系膜体积和肾小球体积共同对CCr和滤过表面具有高度预测性。在高血压患者和尿白蛋白排泄量小于250 mg/24 h的患者中，系膜体积增加，滤过表面积减少。因此，在相对较大的肾小球中系膜扩张对滤过的影响似乎小于在较小的肾小球中系膜体积的类似增加。糖尿病患者肾小球滤过率与滤过表面积之间存在着从超滤到显著低滤的密切关系。
Previously we have shown that relative glomerular mesangial expansion was an important correlate of renal dysfunction in diabetes. To extend the understanding of structural functional relationships, 37 patients with type I diabetes mellitus for 5 to 33 years were studied with multiple creatinine clearance (CCr), urinary albumin excretion, and blood pressure measurements, and percutaneous renal biopsies. Glomerular volume and percent sclerosed glomeruli were determined; quantitiative stereology was performed to determine relative glomerular structural parameters. Per glomerulus we calculated mesangial volume and capillary filtration surface and per patient we estimated capillary filtration surface. Capillary filtration surface per glomerulus or per patient were highly predictive of CCr (r = +0.78, r = +0.79, P < 0.001). There was a significant but weak relationship between CCr and mesangial volume. However, mesangial volume and glomerular volume together were highly predictive of both CCr and filtration surface. Mesangial volume was increased and filtration surface decreased in the hypertensive patients and the patients with urinary albumin excretion less than 250 mg/24 hr. Thus, it appears that mesangial expansion within a relatively large glomerulus has less influence on filtration than does a similar increase in mesangial volume within a smaller glomerulus. There is a strinking relationship between glomerular filtration rate and filtration surface in diabetes throughout the range from hyperfiltration to significant hypofiltration.