在蛋白尿型2型糖尿病患者中，糖尿病视网膜病变对肾病类型的预测能力较差。

Diabetic retinopathy is a poor predictor of type of nephropathy in proteinuric type 2 diabetic patients.

作者信息

Prakash J, Lodha M, Singh S K, Vohra Rubina, Raja R

机构信息

Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005.

出版信息

J Assoc Physicians India. 2007 Jun;55:412-6.

PMID:17879494

Abstract

BACKGROUND

Both diabetic nephropathy (DN) and nondiabetic nephropathy (NDN) are reported to occur in patients with type 2 diabetes mellitus (DM). The precise diagnosis of the type of nephropathy has obvious clinical and prognostic implication. The aim of the study was to evaluate the histologic spectrum of nephropathy in proteinuric type 2 diabetic patients and to find the correlation between type of nephropathy and diabetic retinopathy (DR).

METHODS

Twenty eight proteinuric type 2 diabetic patients were included in the study. Five patients (ADPKD 3 and chronic pyelonephritis 2) were excluded from biopsy. Percutaneous renal biopsy was carried in remaining 23 patients.

RESULTS

There was a preponderance of male (75%) and majority of the patients were in the age group of 30-78 years. Duration of diabetes ranged between 4 months to 25 years with mean +/- SD of 10.53 +/- 7.62 years. The presenting features were nephrotic syndrome 14 (60.9%), non-nephrotic proteinuria 9 (39.1%) and impaired renal function in 19 (82.6%) patients. Renal biopsy in 23 cases revealed; isolated diabetic nephropathy 13 (56.2%), NDN7 (13.43%) and 3 (13%) patients had NDN superimposed on diabetic nephropathy. Membranous nephropathy (2), focal segmental glomerulosclerosis (2), mesangiocapillary glomerulonephritis (1) were the nondiabetic glomerular disease in our type 2 diabetic patients. Chronic pyelonephritis and ischemic interstial nephropathy was the predominant tubulointerstial lesion in this study. Diabetic retinopathy (DR) observed in 12 (75%) patients with biopsy proven DN and absent in 4 (25%) patients with DN. The distribution of renal lesions in patients with DR (n = 15) showed DN in 9 (60%), NDN 3 (20%) and remaining 3 patients had combined lesions. Renal biopsy in 8 patients without DR showed typical DN in 4 (50%) and NDN in 4 (50%) patients.

CONCLUSION

This study demonstrates presence of both glomerular and tubulointerstitial lesions unrelated to diabetes (NDN) in proteinuric type 2 diabetic patients. Further presence or absence of DR was a poor predictor of diabetic nephropathy because DN was noted in 50% of patients without DR and 40% of patients with DR had non-diabetic nephropathy either alone or in combination with DN.

摘要

背景

据报道，2型糖尿病（DM）患者中会出现糖尿病肾病（DN）和非糖尿病肾病（NDN）。准确诊断肾病类型具有明显的临床和预后意义。本研究的目的是评估蛋白尿型2型糖尿病患者的肾病组织学谱，并找出肾病类型与糖尿病视网膜病变（DR）之间的相关性。

方法

本研究纳入了28例蛋白尿型2型糖尿病患者。5例患者（3例常染色体显性多囊肾病和2例慢性肾盂肾炎）被排除在活检之外。对其余23例患者进行了经皮肾活检。

结果

男性占多数（75%），大多数患者年龄在30 - 78岁之间。糖尿病病程为4个月至25年，平均±标准差为10.53±7.62年。主要表现为肾病综合征14例（60.9%），非肾病性蛋白尿9例（39.1%），19例（82.6%）患者肾功能受损。23例患者的肾活检结果显示：孤立性糖尿病肾病13例（56.2%），非糖尿病肾病7例（13.43%），3例（13%）患者为非糖尿病肾病叠加糖尿病肾病。膜性肾病（2例）、局灶节段性肾小球硬化（2例）、系膜毛细血管性肾小球肾炎（1例）是我们2型糖尿病患者中的非糖尿病性肾小球疾病。慢性肾盂肾炎和缺血性间质性肾病是本研究中主要的肾小管间质病变。12例（75%）经活检证实为糖尿病肾病的患者观察到糖尿病视网膜病变（DR），4例（25%）糖尿病肾病患者未观察到。有DR的患者（n = 15）中肾脏病变的分布显示糖尿病肾病9例（60%），非糖尿病肾病3例（20%），其余3例患者有合并病变。8例无DR的患者肾活检显示4例（50%）为典型糖尿病肾病，4例（50%）为非糖尿病肾病。