Different patterns of renal damage in type 2 diabetes mellitus: A multicentric study on 393 biopsies
Different patterns of renal damage in type 2 diabetes mellitus: A multicentric study on 393 biopsies
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DOI：
10.1053/ajkd.2002.31988
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发表时间：
2002-04-01
影响因子：
13.2
通讯作者：
Monga, G
中科院分区：
文献类型：
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作者：
Mazzucco, G;Bertani, T;Monga, G
2型糖尿病患者各种类型肾脏改变的频率在文献中没有明确的定义。报告的差异可能是由种族和地理因素造成的。然而，肾脏中心用于选择接受肾活检的患者的政策也可能会产生影响。本研究报告了在意大利西北部的一组中心使用不同的(限制性[CRPS]或非限制性[CUP])活检政策进行的393例2型糖尿病患者的肾脏活检。根据光镜、免疫荧光和超微结构表现，将病例分为糖尿病肾小球硬化(1类)、普遍血管病变(动脉硬化)和缺血性肾小球改变(2类)、其他肾小球肾炎合并糖尿病肾小球硬化(3a类)或无糖尿病肾小球硬化的肾小球肾炎(3b类)。虽然在第2类患者中没有发现显著差异(分别在CRPS和CUP患者中检测到15%和16%)，但其他两类患者的频率受到活检政策的强烈偏见。CRPS和CUP分别有29%和51%的病例为1级，57%和33%的病例为3级。此外，3a类在杯赛中更常见(67%)，3b类在CRPS中更常见(78%)。我们的发现可能解释来自文献的相互矛盾的数据以及所采用的活检政策类型可能对流行病学评估的影响。这项研究有助于阐明2型糖尿病患者肾脏改变的频率，并建议更广泛地使用肾脏活检来获得可靠的预后指征，并计划合理的治疗方法。(C)2002年，由国家肾脏基金会公司提供。
The frequency of various types of renal changes in patients with type 2 diabetes is not clearly defined in the literature. Reported discrepancies likely are caused by ethnic and geographic factors. However, policies used in nephrological centers for the selection of patients to undergo renal biopsy also may have an influence. The present study reports 393 renal biopsies in patients with type 2 diabetes performed in a group of centers in northwestern Italy using different (restricted [CRPs] or unrestricted [CUP]) biopsy policies. On the basis of light microscopic, immunofluorescence, and ultrastructural findings, cases were subdivided into three classes characterized by the presence of diabetic glomerulosclerosis (class 1), prevailing vascular (arterioarterioloscierotic) and ischemic glomerular changes (class 2), other glomerulonephritides superimposed on diabetic glomerulosclerosis (class 3a), or glomerulonephritides without the presence of diabetic glomerulosclerosis (class 3b). Although no significant differences were found for class 2 (detected in 15% and 16% of patients from CRPs and the CUP, respectively), the frequency of the other two classes was strongly biased by the biopsy policy. Class 1 was found in 29% and 51% of cases, and class 3 in 57% and 33% of cases from CRPs and the CUP, respectively. Moreover, class 3a was more common (67%) in the CUP, and class 3b (78%) in CRPs. Our findings may explain conflicting data from the literature and the influence that type of adopted biopsy policy may have on an epidemiological evaluation. This study helps clarify the frequency of renal changes In patients with type 2 diabetes and suggests more extensive use of renal biopsy to obtain reliable prognostic Indications and plan a rational therapeutic approach. (C) 2002 by the National Kidney Foundation, Inc.