CLINICAL AND HISTOLOGICAL CORRELATIONS OF DECLINE IN RENAL-FUNCTION IN DIABETIC-PATIENTS WITH PROTEINURIA
CLINICAL AND HISTOLOGICAL CORRELATIONS OF DECLINE IN RENAL-FUNCTION IN DIABETIC-PATIENTS WITH PROTEINURIA
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DOI：
10.2337/diabetes.43.8.1046
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发表时间：
1994-08-01
期刊：
影响因子：
7.7
通讯作者：
MARTIN, FIR
中科院分区：
文献类型：
--
作者：
TAFT, JL;NOLAN, CJ;MARTIN, FIR
对47例糖尿病肾病患者（29例I型，18例II型）的肾功能和血压（BP）（38例高血压患者接受或不接受血管紧张素转换酶[ACE]抑制剂依那普利[10 mg]治疗）进行了4年以上的随访。对所有患者进行经皮肾活检，并在4年后对19例有代表性的高血压患者进行重复检查。组织形态计量学测量平均肾小球体积（MGV）、间质纤维化（IF）、毛细血管体积和硬化肾小球（GS）。4年后肌酐清除率（CCr）平均下降11.8%，治疗组或糖尿病类型之间无差异。治疗初期及治疗期间血压与血肌酐、CCr呈显著正相关（P < 0.01）。I型和II型患者或高血压治疗组之间无组织形态学差异。所有患者和I型患者的初始IF与初始、终末血肌酐和CCr相关（P < 0.05），I型患者的MGV与CCr呈负相关（P < 0.05）。4年后，IF（24.8 vs. 30.0%，P < 0.01）和GS（26 vs. 37%，P < 0.05）显著升高，且IF升高与CCr下降相关（P < 0.01）。蛋白尿和HbA 1与功能或结构指标无关。在这项对糖尿病肾病患者的纵向研究中，血压与肾功能密切相关，但依那普利治疗与其他高血压药物治疗之间无差异。肾功能和组织学之间的相关性在进入和4年后表明，IF是糖尿病肾病肾功能的共同决定因素。
In 47 patients with diabetic nephropathy (29 type I, 18 type II) renal function and blood pressure (BP) (treated with or without an angiotensin-converting enzyme [ACE] inhibitor, enalapril [10 mg], in 38 hypertensive patients) were followed over 4 years. A percutaneous renal biopsy was performed in all patients initially and repeated in a representative 19 patients with treated hypertension after 4 years. Mean glomerular volume (MGV), interstitial fibrosis (IF), capillary volume, and sclerosed glomeruli (GS) were measured histomorphometrically. Mean fall in creatinine clearance (CCr) was 11.8% after 4 years with no difference between treatment groups or type of diabetes. BP both initially and during treatment correlated with initial and final serum creatinine and CCr (P < 0.01). There were no histomorphometric differences between type I and type II patients or hypertension treatment groups. Initial IF correlated with initial and final serum creatinine and CCr (P < 0.05) in all patients and type I patients alone, MGV correlated inversely with CCr in type I patients (P < 0.05). After 4 years, IF (24.8 vs. 30.0%, P < 0.01) and GS (26 vs. 37%, P < 0.05) increased significantly, and increase in IF correlated with fall in CCr (P < 0.01). Proteinuria and HbA(1) did not correlate with indexes of function or structure. In this longitudinal study of patients with diabetic nephropathy, there was a close relation between BP and renal function but no difference between treatment with enalapril and other hypertensive agents. The correlations between renal function and histology at entry and after 4 years suggest that IF is a co-determinant of renal function in diabetic nephropathy.