Kida H, Yoshimura M, Ikeda K, Saitou Y, Noto Y
Department of Internal Medicine, Kanazawa National Hospital, Ishikawa, Japan.
J Diabet Complications. 1991 Apr-Sep;5(2-3):82-3. doi: 10.1016/0891-6632(91)90025-k.
To elucidate the characteristics of diabetic nodular lesions and the process of progression of diabetic glomerulosclerosis, kidney specimens obtained from 185 patients with non-insulin-dependent diabetes mellitus (NIDDM) were observed using light, electron, and immunofluorescence microscopes. The results suggest the following. First, there are two distinct subtypes of nodular lesions: One is formed by the progression and expansion of diffuse lesions; the other, showing a concentrically layered structure, is probably formed in the process of reconstruction of mesangiolysis. Second, there are three phases in the process of progression of diabetic glomerulosclerosis: In the first phase, arteriolosclerosis and diffuse lesions appear; in the second phase, mesangiolysis and nodular lesions develop in association with moderately advanced arteriolosclerosis; and in the third phase, exudative lesions and hyalinized glomeruli appear in association with advanced arteriolosclerosis together with advanced interstitial lesions. In the progression of the phases and in the development of mesangiolysis and layered nodular lesions, disturbed blood flow into glomeruli in consequence of diabetic arteriolosclerosis could be essential.
为阐明糖尿病结节性病变的特征及糖尿病肾小球硬化的进展过程，我们使用光学显微镜、电子显微镜和免疫荧光显微镜观察了185例非胰岛素依赖型糖尿病（NIDDM）患者的肾脏标本。结果如下。第一，结节性病变有两种不同的亚型：一种是由弥漫性病变进展和扩展形成；另一种呈现同心层状结构，可能是在系膜溶解重建过程中形成。第二，糖尿病肾小球硬化的进展过程有三个阶段：第一阶段，出现小动脉硬化和弥漫性病变；第二阶段，系膜溶解和结节性病变与中度进展的小动脉硬化相关联而发展；第三阶段，渗出性病变和玻璃样变的肾小球与重度小动脉硬化以及重度间质病变相关联而出现。在各阶段的进展以及系膜溶解和层状结节性病变的发展过程中，糖尿病小动脉硬化导致的肾小球血流紊乱可能至关重要。
