Structural changes in renal arterioles in Type I diabetic patients
Structural changes in renal arterioles in Type I diabetic patients
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DOI：
10.1007/s00125-002-0780-2
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发表时间：
2002-04-01
期刊：
影响因子：
8.2
通讯作者：
Bangstad, HJ
中科院分区：
文献类型：
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作者：
Osterby, R;Hartmann, A;Bangstad, HJ
目标/假设。我们的目标是在一项对微量白蛋白尿糖尿病患者的随访研究中获得有关微动脉结构的数据。18例I型(胰岛素依赖型)糖尿病患者在基线时和8年后进行肾活检。定期检测白蛋白排泄率、血压和糖化血红蛋白(1C)，并在肾活检时测量肾小球滤过率(GFR)。活检组织嵌于塑料块中，连续切片1微米。在相隔25微米的水平上，在电子显微镜下识别传入和传出小动脉的轮廓并将其数字化。测量细胞外基质的体积分数，得到基质、基质、内皮和管腔厚度的估计值。同时对基线和随访活检进行研究。传入动脉(p=0.0001)和传出小动脉(p=0.0004)的基质体积分数显著增加。在这8年中，中膜和基质的估计厚度增加，而内皮细胞厚度减少。糖尿病肾小球病变的参数与8年时活检的小动脉参数、基底膜厚度与传入基质体积分数之间存在相关性：r=0.74，p=0.0005。8年以上肾小球病变加重与小动脉结构呈正相关。微动脉参数与白蛋白排泄率(AER)呈正相关，与GFR呈负相关。在伴有微量白蛋白尿的I型糖尿病患者中，基质的微动脉积聚与肾小球内发生的微动脉积聚平行，并与8年来的功能参数有关。这些变化被认为是糖尿病肾脏结构损害的重要组成部分，是糖尿病肾病发生的基础。
Aims/hypothesis. We aimed to obtain data on arteriolar structure in a follow-up study of microalbuminuric diabetic patients.Methods. Kidney biopsies were obtained at baseline and after 8 years in 18 Type I (insulin-dependent) diabetic patients. Albumin excretion rate, blood pressure and HbA(1C) were measured regularly, and the glomerular filtration rate (GFR) was measured at the time of the kidney biopsy. The biopsy was embedded into plastic blocks and serially sectioned with 1 mum sections. In levels 25 mum apart, afferent and efferent arteriolar profiles were identified and digitised in the electron microscope. The extra-cellular matrix as volume fraction of the media was measured, and estimates of thickness of matrix, media, endothelium and lumen were obtained. Baseline and follow-up biopsies were studied concomitantly.Results. A large increase was seen in matrix volume fraction in afferent (p = 0.0001) and in efferent arterioles (p = 0.0004). Estimated thickness of media and matrix increased, whereas endothelial cell thickness decreased, over the 8 years. There was a correlation between the parameters of diabetic glomerulopathy and arteriolar parameters in the biopsies done at 8 years, basement membrane thickness compared with afferent matrix volume fraction: r = 0.74, p = 0.0005. Also aggravation of glomerulopathy and arteriolar structure over 8 years showed positive correlation. Arteriolar parameters correlated with the albumin excretion rate (AER) and inversely with GFR.Conclusion/interpretation. The arteriolar accumulation of matrix parallels that taking place in glomeruli and shows association with functional parameters over 8 years in Type I diabetic patients with microalbuminuria. These changes are considered an important part of the structural lesions in the diabetic kidney underlying the development of diabetic nephropathy.