单肾不会加速1型糖尿病患者糖尿病肾病病变的发展速度。

Having one kidney does not accelerate the rate of development of diabetic nephropathy lesions in type 1 diabetic patients.

作者信息

Chang Shirley, Caramori M Luiza, Moriya Rika, Mauer Michael

机构信息

Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.

出版信息

Diabetes. 2008 Jun;57(6):1707-11. doi: 10.2337/db07-1610. Epub 2008 Mar 28.

DOI:10.2337/db07-1610

PMID:18375439

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3645267/

Abstract

OBJECTIVE

Reduced nephron number is hypothesized to be a risk factor for chronic kidney disease and hypertension. Whether reduced nephron number accelerates the early stages of diabetic nephropathy is unknown. This study investigated whether the rate of development of diabetic nephropathy lesions was different in type 1 diabetic patients with a single (transplanted) kidney compared with patients with two (native) kidneys.

RESEARCH DESIGN AND METHODS

Three groups of volunteers were studied: 28 type 1 diabetic kidney transplant recipients with 8-20 years of good graft function, 39 two-kidney patients with duration of type 1 diabetes matched to the time since transplant in the one-kidney group, and 30 age-matched normal control subjects. Electron microscopic morphometry was used to estimate glomerular structural parameters on 3.0 +/- 1.4 glomeruli per biopsy.

RESULTS

In the one- versus two-kidney diabetic subject groups, respectively, serum creatinine (means +/- SD 1.3 +/- 0.4 vs. 0.9 +/- 0.2 mg/dl; P < 0.001), systolic blood pressure (133 +/- 13 vs. 122 +/- 11 mmHg; P < 0.001), and albumin excretion rate (median [range] 32.1 microg/min [2-622] vs. 6.8 microg/min [2-1,495]; P = 0.006) were higher. There were no differences in the one- versus two-kidney diabetic subject groups, respectively, in glomerular basement membrane width (median [range] 511 nm [308-745] vs. 473 nm [331-814]), mesangial fractional volume (mean +/- SD 0.30 +/- 0.06 vs. 0.27 +/- 0.07), mesangial matrix fractional volume (0.16 +/- 0.05 vs. 0.16 +/- 0.06), and mesangial matrix fractional volume per total mesangium (0.61 +/- 0.07 vs. 0.64 +/- 0.09). However, these glomerular structural parameters were statistically significantly higher in both diabetic subject groups compared with normal control subjects. Results were similar when patients receiving ACE inhibitors were excluded from the analyses.

CONCLUSIONS

Reduced nephron number is not associated with accelerated development of diabetic glomerulopathy lesions in type 1 diabetic patients.

摘要

目的

肾单位数量减少被认为是慢性肾脏病和高血压的一个危险因素。肾单位数量减少是否会加速糖尿病肾病的早期进程尚不清楚。本研究调查了单肾（移植肾）的1型糖尿病患者与双肾（自身肾）的患者相比，糖尿病肾病病变的发展速率是否存在差异。

研究设计与方法

研究了三组志愿者：28例移植肾功能良好8 - 20年的1型糖尿病肾移植受者，39例1型糖尿病病程与单肾组移植后时间相匹配的双肾患者，以及30例年龄匹配的正常对照者。采用电子显微镜形态计量学方法，对每份活检标本中的3.0±1.4个肾小球估计肾小球结构参数。

结果

单肾与双肾糖尿病患者组相比，血清肌酐（均值±标准差1.3±0.4 vs. 0.9±0.2mg/dl；P<0.001）、收缩压（133±13 vs. 122±11mmHg；P<0.001）和白蛋白排泄率（中位数[范围]32.1μg/min[2 - 622] vs. 6.8μg/min[2 - 1495]；P = 0.006）均更高。单肾与双肾糖尿病患者组相比，肾小球基底膜宽度（中位数[范围]511nm[308 - 745] vs. 473nm[331 - 814]）、系膜分数容积（均值±标准差0.30±0.06 vs. 0.27±0.07）、系膜基质分数容积（0.16±0.05 vs. 0.16±0.06）以及每总系膜的系膜基质分数容积（0.61±0.07 vs. 0.64±0.09）均无差异。然而，与正常对照者相比，两组糖尿病患者的这些肾小球结构参数在统计学上均显著更高。将接受血管紧张素转换酶抑制剂治疗的患者排除在分析之外时，结果相似。