Cellular basis of diabetic nephropathy 1. Study design and renal structural-functional relationships in patients with long-standing type 1 diabetes
Cellular basis of diabetic nephropathy 1. Study design and renal structural-functional relationships in patients with long-standing type 1 diabetes
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DOI：
10.2337/diabetes.51.2.506
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发表时间：
2002-02-01
期刊：
影响因子：
7.7
通讯作者：
Mauer, M
中科院分区：
文献类型：
--
作者：
Caramori, ML;Kim, Y;Mauer, M
这项研究旨在阐明1型糖尿病患者中肾病风险或保护肾病的风险的细胞基础。进入标准包括糖尿病的持续时间大于或等于8 eax（平均持续时间，22。5年）和肾小球过滤率（GFR）> 30 ml（。）最小（-1。）1.73 m（-2）患者，分类为1.73 m（-2）。估计的肾小球扩展率的基础，为“快速轨道”（上五五五分之一）或“慢轨”（下五五五分之一）。总共88例患者是正常珠尿症，17例是微珠尿素，19例是蛋白尿。这三组均增加了肾小球基底膜（GBM）宽度和肾小球分数体积[W（MES/GLOM）]，并且从正常白蛋白尿，到微珠尿症，到蛋白尿，但在组之间有相当大的重叠。 VV（MES/ GLOM）（r = 0.75，p <0.001）和GBM宽度（r = 0.63，p <0.001）与白蛋白排泄率（AER）相关，而每个glomerulus的外围GBM表面密度）（r = 0.50，p <0.001）和vv（mes/glom）（r = -0.48，p <0.001）与GFR相关。 VV（MES/GLOM）和GBM宽度共同解释了AER变异性的59％。 GFR由SV（PGBM/Glom），AER和性别预测。快速轨道患者的血糖控制较差，AER更高，GFR更高，高血压和视网膜病变，并且如预期的那样，肾小球病变比慢轨患者差。因此，肾小球结构与肾功能之间存在牢固的关系，但是AER类别之间存在相当大的结构重叠。鉴于正常珠尿症患者可能患有晚期肾小球病，因此基于肾小球结构的慢轨患者可以比单独使用AER更好地识别受保护的患者。
This study was designed to elucidate the cellular basis of risk of or protection from nephropathy in patients with type 1 diabetes. Entry criteria included diabetes duration of greater than or equal to8 yeaxs (mean duration, 22.5 years) and glomerular filtration rate (GFR) >30 ml (.) min(-1 .) 1.73 m(-2) Patients were classified, on the basis of the estimated rate of mesangial expansion, as "fast-track" (upper quintile) or "slow-track" (lower quintile). A total of 88 patients were normoalbuminuric, 17 were microalbuminuric, and 19 were proteinuric. All three groups had increased glomerular basement membrane (GBM) width and mesangial fractional volume [W(Mes/glom)], with increasing severity from normoalbuminuria, to microalbuminuria, to proteinuria but with considerable overlap among groups. Vv(Mes/glom) (r = 0.75, P < 0.001) and GBM width (r = 0.63, P < 0.001) correlated with albumin excretion rate (AER), whereas surface density of peripheral GBM per glomerulus [Sv(PGBM/ glom)] (r = 0.50, P < 0.001) and VV(Mes/glom) (r = -0.48, P < 0.001) correlated with GFR. Vv(Mes/glom) and GBM width together explained 59% of AER variability. GFR was predicted by Sv(PGBM/glom), AER, and sex. Fast-track patients had worse glycemic control, higher AER, lower GFR, more hypertension and retinopathy, and, as expected, worse glomerular lesions than slow-track patients. Thus, there are strong relationships between glomerular structure and renal function across the spectrum of AER, but there is considerable structural overlap among AER categories. Given that normoalbuminuric patients may have advanced glomerulopathy, the selection of slow-track patients based on glomerular structure may better identify protected patients than AER alone.