Moriya Tatsumi, Tanaka Keiji, Hosaka Tatsuki, Hirasawa Yoko, Fujita Yoshikuni
Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara 228-8555, Japan.
Diabetes Res Clin Pract. 2008 Dec;82(3):298-304. doi: 10.1016/j.diabres.2008.08.015.
Baseline glomerular structure in microalbuminuric (MA) and proteinuric Caucasian type 2 diabetic patients predicted progressive glomerular filtration rate decline while baseline urinary albumin excretion (UAE) did not. Little is known about whether or not renal structure at the early stages of diabetic nephropathy (DN) in type 2 diabetic patients can predict further functional development of DN. Baseline renal structure and function and follow-up data of renal function were examined in 17 type 2 diabetic patients (11 men, 45+/-7 (mean+/-S.D.) years old) with known diabetes duration 11+/-8 years without definable renal disease other than DN. Six patients showed normoalbuminuria (NA), 11 microalbuminuria (MA), and were followed up for 6.4+/-1.8 years after the baseline renal biopsy. Light and electron microscopic morphometric analyses provided quantitative glomerular and tubulointerstitial structural changes. No statistically significant difference was observed in hemoglobin A1c (HbA1c) values or mean blood pressure (MBP) between baseline and follow-up, even though the number of patients placed on antihypertensive drugs increased from 3 to 7. Follow-up UAE was not significantly different from the baseline UAE although 13 of 17 cases showed an increase. Baseline UAE did not correlate with the follow-up UAE or morphometric measures. Glomerular basement membrane width and volume fraction of the mesangium and mesangial matrix positively correlated with follow-up UAE. In NA and MA Japanese type 2 diabetic patients, baseline renal structural measures are more reliable indicators for the development of UAE than baseline UAE.
微量白蛋白尿（MA）和蛋白尿的白种人2型糖尿病患者的基线肾小球结构可预测肾小球滤过率的进行性下降，而基线尿白蛋白排泄率（UAE）则不能。对于2型糖尿病患者糖尿病肾病（DN）早期的肾脏结构是否能预测DN的进一步功能发展，人们知之甚少。我们对17例2型糖尿病患者（11例男性，年龄45±7（均值±标准差）岁，已知糖尿病病程11±8年，除DN外无明确的肾脏疾病）的基线肾脏结构和功能以及肾功能的随访数据进行了研究。6例患者表现为正常白蛋白尿（NA），11例为微量白蛋白尿（MA），在基线肾脏活检后随访6.4±1.8年。光镜和电镜形态计量分析提供了定量的肾小球和肾小管间质结构变化。尽管使用抗高血压药物的患者数量从3例增加到7例，但基线和随访时的糖化血红蛋白（HbA1c）值或平均血压（MBP）均未观察到统计学上的显著差异。随访时的UAE与基线UAE无显著差异，尽管17例中有13例升高。基线UAE与随访时的UAE或形态计量指标无相关性。肾小球基底膜宽度、系膜和系膜基质的体积分数与随访时的UAE呈正相关。在NA和MA的日本2型糖尿病患者中，基线肾脏结构指标比基线UAE更能可靠地预测UAE的发展。
