Nash D A, Rogers P W, Langlinais P C, Bunn S M
Am J Med. 1975 Aug;59(2):191-9. doi: 10.1016/0002-9343(75)90353-8.
The pathophysiology of the microangiopathy of diabetes mellitus is poorly understood, and the relevance of carbohydrate intolerance remains uncertain. Four patients are presented with renal abnormalities suggestive of diffuse diabetic glomeruloscierosis. These patients have no evidence of carbohydrate intolerance by standard clinical technics. A familial incidence of diabetes mellitus and delayed insulin response to an oral glucose load support a classification of prediabetes or suspected diabetes mellitus for these patients. Early intercapillary nodule formation was seen in only two of the four patients. In the absence of this infrequent pathognomonic finding, an alternate approach to the diagnosis of diabetic glomerulosclerosis is suggested. Diffuse glomerular capillary basement membrane thickening, consistently present with diabetic glomerulosclerosis, is demonstrated by measurements utilizing the latex microsphere technic. The mean glomerular capillary basement membrane thickness of these patients was 4,403 A, compared with the control value of 3.098 A (P less than 0.001). Other pathologic findings suggestive of diabetic nephropathy include efferent arteriolosclerosis and linear immunofluorescence without electron dense deposits or inflammation. Skeletal muscle capillary basement membranes of all four patients also demonstrated significant thickening. The mean value for the patients was 1,510 A, as compared with a control value of 961 A (P less than 0.001). The importance of this muscle capillary basement membrane thickening to the diagnosis of diabetic microangiopathy is discussed. The pathologic alterations in the renal biopsy specimens and the demonstration of muscle capillary basement membrane thickening strongly suggest that diabetic glomerulosclerosis may occur in the absence of overt clinical carbohydrate intolerance.
糖尿病微血管病变的病理生理学尚未完全明确，碳水化合物不耐受的相关性也仍不确定。本文报告了4例有提示弥漫性糖尿病肾小球硬化症肾脏异常的患者。通过标准临床技术，这些患者没有碳水化合物不耐受的证据。糖尿病的家族发病率以及口服葡萄糖负荷后胰岛素反应延迟，支持将这些患者分类为糖尿病前期或疑似糖尿病。在这4例患者中，仅2例出现了早期毛细血管间结节形成。在缺乏这种不常见的特征性表现的情况下，本文提出了一种诊断糖尿病肾小球硬化症的替代方法。利用乳胶微球技术测量发现，弥漫性肾小球毛细血管基底膜增厚与糖尿病肾小球硬化症始终相关。这些患者的平均肾小球毛细血管基底膜厚度为4403埃，而对照组值为3098埃（P<0.001）。其他提示糖尿病肾病的病理表现包括出球小动脉硬化以及无电子致密沉积物或炎症的线性免疫荧光。所有4例患者的骨骼肌毛细血管基底膜也显示出明显增厚。患者的平均值为1510埃，而对照组值为961埃（P<0.001）。本文讨论了这种肌肉毛细血管基底膜增厚对糖尿病微血管病变诊断的重要性。肾活检标本中的病理改变以及肌肉毛细血管基底膜增厚的表现强烈提示，糖尿病肾小球硬化症可能在无明显临床碳水化合物不耐受的情况下发生。
