Neovascularization at the vascular pole region in diabetic glomerulopathy
Neovascularization at the vascular pole region in diabetic glomerulopathy
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DOI：
10.1093/ndt/14.2.348
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发表时间：
1999-02-01
影响因子：
6.1
通讯作者：
Walker, JD
中科院分区：
文献类型：
--
作者：
Osterby, R;Asplund, J;Walker, JD
背景资料。糖尿病肾病与累及所有间隔区的肾脏结构改变有关。最具特点的是糖尿病肾小球病变。对肾病早期的组织学变化的研究包括肾小球病变和肾小球旁结构。在糖尿病视网膜病变中众所周知的新生血管，在肾脏中也被观察到。本研究涉及对糖尿病肾病早期血管极部新生血管频率的估计。肾活检1微米连续切片测量肾小球血管极面积时，发现肾小球血管极处有额外的传出小动脉。偶见有一支以上的传出小动脉。本研究的目的是估计糖尿病患者和非糖尿病对照组中这种现象的频率，糖尿病患者根据白蛋白排泄率水平进行分类。新生血管首先在伴有微量白蛋白尿的IDDM患者中观察到。一些病例在所有研究的肾小球中都出现了这种现象。随着对许多肾脏活检的检查继续进行，在非糖尿病对照组和一名正常白蛋白尿的IDDM患者中也观察到了这一现象。然而，在白蛋白排泄率升高的患者中，这种频率在统计学上显著增加。在这组患者中，新生血管的发生率与糖尿病肾小球病变的严重程度有很强的相关性。正常肾脏偶见血管极部血管异常，而糖尿病肾小球病变患者血管极部血管异常增多。这种异常可能是长期存在的糖尿病肾小球病变的结果，并可能导致较不明显的白蛋白排泄增加。
Background. Diabetic nephropathy is associated with renal structural changes involving ail of the compartments. Most characteristic is the diabetic glomerulopathy. Studies of the histological changes during the early phases of nephropathy have included the glomerulopathy and also the juxtaglomerular structures. Neovascularization, well-known in diabetic retinopathy, has also been observed in the kidney. The present study concerns estimates of frequency of neovascularization at the vascular pole region in early stages of diabetic nephropathy.Methods. Extra efferent arterioles at the glomerular vascular pole were detected during measurements of the vascular pole area applying 1-mu m serial sections through kidney biopsies. It was observed that more than one efferent arteriole existed occasionally. The present study was carried out with the aim of estimating the frequency of this phenomenon in diabetic patients and in non-diabetic controls, the diabetic patients categorized according to the level of albumin excretion rate.Results. Neovascularization was first observed in IDDM patients with microalbuminuria. Some of the cases presented the phenomenon in all of the glomeruli studied. As the examinations of many kidney biopsies continued the phenomenon was observed also in the non-diabetic control group and in one IDDM patient with normoalbuminuria. However, the frequency was statistically highly significantly increased in patients with elevated albumin-excretion. Within this group a strong correlation between frequency of neovascularization and the severity of diabetic glomerulopathy is seen.Conclusions. The vascular abnormality localized to the vascular pole region is observed occasionally in the normal kidney, but the frequency is increased in patients with diabetic glomerulopathy. The abnormality may develop as a consequence of a long-standing diabetic glomerulopathy and might lead to less pronounced elevation of albumin excretion.