OBSERVATIONS OF GLOMERULAR EPITHELIAL-CELL STRUCTURE IN PATIENTS WITH TYPE-I DIABETES-MELLITUS
OBSERVATIONS OF GLOMERULAR EPITHELIAL-CELL STRUCTURE IN PATIENTS WITH TYPE-I DIABETES-MELLITUS
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DOI：
10.1038/ki.1987.268
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发表时间：
1987-11-01
影响因子：
19.6
通讯作者：
MAUER, SM
中科院分区：
文献类型：
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作者：
ELLIS, EN;STEFFES, MW;MAUER, SM
显性蛋白尿是糖尿病肾病的标志，而微量白蛋白尿被认为是糖尿病肾病后期发病的预测因子。然而，糖尿病异常尿蛋白渗漏的机制尚未确定。我们研究了28例I型糖尿病患者7至33年。在每例患者中获得肌酐清除率、尿白蛋白排泄率（UAE）和多种血压。对每例患者和28例正常人进行肾活检。 采用定量体视学方法测定足突（FP）宽度、滤过缝长度密度（FSLV）和滤过缝长度/肾小球（FSLG）。UAE < 250 mg/24 hr的糖尿病患者FP宽度略宽于正常人，而UAE > 250 mg/24 hr的糖尿病患者FP宽度明显宽于这两组。正常人和UAE < 250 mg/24 hr的糖尿病患者FSLV和FSLG相似，但UAE > 250 mg/24 hr的糖尿病患者两者均减少。UAE与FP宽度相关FSLG（P <0.01）和最精确FSLV（P < 0.001）。微量白蛋白尿的糖尿病患者的所有结构参数测量值与UAE的糖尿病患者在正常范围内没有差异。上皮细胞结构的紊乱存在于糖尿病，尤其是肾病患者中。蛋白尿和上皮细胞结构之间的确切关系仍有待阐明。
Overt proteinuria is a hallmark of diabetic nephropathy while microalbuminuria is thought to be a predictor of later onset of diabetic nephropathy. Yet the mechanisms for abnormal urinary protein leak in diabetes have not been defined. We studied 28 patients with type I diabetes for 7 to 33 years. Creatinine clearance, urinary albumin excretion rate (UAE), and multiple blood pressures were obtained in each patient. A renal biopsy was performed in each patient and in 28 normal subjects. Quantitative stereology was used to determine foot process (FP) width, filtration slit length density (FSLV) and filtration slit length/glomerulus (FSLG). FP width was slightly wider than normal in diabetic patients with UAE < 250 mg/24 hr while FP was significantly wider than both of these groups in diabetics with UAE > 250 mg/24 hr. FSLV and FSLG were similar in normals and diabetics with UAE < 250 mg/24 hr but both were reduced in diabetics with UAE > 250 mg/24 hr. UAE correlated with FP width (P < 0.05), FSLG (P < 0.01) and most precisely and FSLV (P < 0.001). Diabetics with microalbuminuria had values for all the structural parameters measured here not different from diabetics with UAE in the normal range. Perturbations of epithelial cell structure are present in diabetes mellitus especially in patients with nephropathy. The exact relationships between albuminuria and epithelial cell structure remains to be elucidated.