Renal biopsy in patients with type 2 diabetes mellitus: indications and nature of the lesions.
Renal biopsy in patients with type 2 diabetes mellitus: indications and nature of the lesions.
复制标题
DOI：
10.4103/0256-4947.57167
复制
发表时间：
2009-11
影响因子：
1.6
通讯作者：
Hussain N
中科院分区：
文献类型：
--
作者：
Ghani AA;Al Waheeb S;Al Sahow A;Hussain N
非糖尿病性肾病（NDRD）在2型糖尿病患者中的患病率因选择标准和研究人群的不同而有很大差异。本研究的目的是评估2型糖尿病患者疑似NDRD的肾脏活检，并将病理与临床和实验室结果联系起来。我们选择并回顾了2006年1月至2008年12月在一家医院对临床怀疑为NDRD的2型糖尿病患者进行的活检。将临床和实验室数据与组织病理学结果相结合进行分析。患者分为分离性DGS组I组和DGS之上的NDRD组II组。2型糖尿病患者行活检31例；男性17例（54.8%）。平均年龄50.68岁（11.29岁）。糖尿病的平均病程为9.33（3.6）年。肾活检显示，研究组中有14例（45.2%）患者在DGS之上表现为NDRD。月牙状肾小球肾炎最常见，3例（21.4%），其次为急性肾小管间质性肾炎，高血压改变2例（14.4%）。其他表现包括IgA肾病、原发性局灶节段性肾小球硬化、横纹肌溶解、膜增生性肾小球肾炎各1例（7.1%）。ⅰ组蛋白尿4.97 (2.08)gm/24小时尿显著高于ⅱ组（2.72 (1.09)gm/24小时尿）（P= 0.003）。两组患者在年龄、糖尿病病程、性别、是否存在高血压、血尿、血清肌酐、肾小球滤过率等方面无显著差异。本研究显示月牙状肾小球肾炎是糖尿病患者中最常见的NDRD。在DGS合并NDRD的患者中，蛋白尿水平较高。因此，当糖尿病患者的临床情况不典型时，应进行肾活检。
The prevalence of non diabetic renal disease (NDRD) among patients with type 2 diabetes mellitus varies widely depending on the selection criteria and the populations being studied. The aim of this study was to evaluate the renal biopsies performed on type 2 diabetic patients for suspicion of NDRD and to correlate the pathological with the clinical and laboratory findings. We selected and reviewed biopsies performed on type 2 diabetics for clinically suspected NDRD from January 2006 to December 2008 at a single hospital. Clinical and laboratory data were analyzed in relation to the histopathology findings. Patients were grouped into either group I with isolated DGS or group II with NDRD on top of DGS. Thirty-one biopsies were performed on type 2 diabetic patients; Seventeen patients (54.8%) were males. Mean age was 50.68 (11.29) years. The mean duration of diabetes was 9.33 (3.6) years. Renal biopsy showed that among the studied group 14 patients (45.2%) showed NDRD on top of DGS. Crescentic glomerulonephritis was the commonest finding seen in 3 cases (21.4% of group II cases) followed by acute tubulointerstitial nephritis and hypertensive changes each was seen in 2 cases (14.4%). Other findings included IgA nephropathy, primary focal segmental glomerulosclerosis, rhabdomyolysis, membranoproliferative glomerulonephritis each of them was seen in one case (7.1%). Group I had a significantly higher level of proteinuria 4.97 (2.08) gm/24 hrs urine than group II 2.72 (1.09) gm/24 hrs urine (P=.003). There was no significant difference between the two groups in age, duration of diabetes, gender, presence of hypertension, hematuria, serum creatinine or glomerular filtration rate. The present study showed that crescentic glomerulonephritis is the commonest NDRD among diabetic patients. A higher level of proteinuria was reported among those with NDRD superimposed on DGS. So, Renal biopsy should be performed in diabetics when the clinical scenario is atypical.