Musso Carla, Javor Edward, Cochran Elaine, Balow James E, Gorden Phillip
Clinical Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892-1770, USA.
Clin J Am Soc Nephrol. 2006 Jul;1(4):616-22. doi: 10.2215/CJN.01271005. Epub 2006 Apr 26.
Diabetic nephropathy is the leading cause of ESRD in the United States. Why the pathogenic mechanisms lead to nephropathy in certain patients with type 1 and 2 diabetes and spare others is unclear, but it is clear that hyperglycemia and glomerular hyperfiltration are important factors. In patients with syndromes of extreme insulin resistance, proteinuric forms of renal disease are common, but it is surprising to find that the renal pathology usually is not diabetic nephropathy. For instance, in the lipodystrophy syndromes, membranoproliferative glomerulonephritis type 1 and type 2, focal segmental glomerulosclerosis, and also diabetic nephropathy are seen. In the syndromes of autoantibodies to the insulin receptor, the various forms of lupus glomerulonephritis are seen. Even in patients with type 2 diabetes, the renal pathology may not be diabetic nephropathy. Therefore, in patients with syndromic forms of insulin resistance and type 2 diabetes, renal biopsy has an important role in defining the pathology that leads to proteinuric nephropathy and in formulating a therapeutic approach. It is the purpose of this article to review these unusual aspects of proteinuric nephropathy in patients with diabetes.
糖尿病肾病是美国终末期肾病的主要病因。1型和2型糖尿病患者中，某些患者出现肾病而另一些患者未出现的致病机制尚不清楚，但高血糖和肾小球高滤过是重要因素这一点是明确的。在极端胰岛素抵抗综合征患者中，蛋白尿性肾病很常见，但令人惊讶的是，肾脏病理通常并非糖尿病肾病。例如，在脂肪营养不良综合征中，可见1型和2型膜增生性肾小球肾炎、局灶节段性肾小球硬化，以及糖尿病肾病。在胰岛素受体自身抗体综合征中，可见各种形式的狼疮性肾小球肾炎。即使在2型糖尿病患者中，肾脏病理也可能不是糖尿病肾病。因此，在伴有胰岛素抵抗综合征和2型糖尿病的患者中，肾活检在明确导致蛋白尿性肾病的病理以及制定治疗方案方面具有重要作用。本文旨在综述糖尿病患者蛋白尿性肾病的这些不寻常方面。
