Department of Pathology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
J Am Soc Nephrol. 2010 Apr;21(4):556-63. doi: 10.1681/ASN.2010010010. Epub 2010 Feb 18.
Although pathologic classifications exist for several renal diseases, including IgA nephropathy, focal segmental glomerulosclerosis, and lupus nephritis, a uniform classification for diabetic nephropathy is lacking. Our aim, commissioned by the Research Committee of the Renal Pathology Society, was to develop a consensus classification combining type1 and type 2 diabetic nephropathies. Such a classification should discriminate lesions by various degrees of severity that would be easy to use internationally in clinical practice. We divide diabetic nephropathy into four hierarchical glomerular lesions with a separate evaluation for degrees of interstitial and vascular involvement. Biopsies diagnosed as diabetic nephropathy are classified as follows: Class I, glomerular basement membrane thickening: isolated glomerular basement membrane thickening and only mild, nonspecific changes by light microscopy that do not meet the criteria of classes II through IV. Class II, mesangial expansion, mild (IIa) or severe (IIb): glomeruli classified as mild or severe mesangial expansion but without nodular sclerosis (Kimmelstiel-Wilson lesions) or global glomerulosclerosis in more than 50% of glomeruli. Class III, nodular sclerosis (Kimmelstiel-Wilson lesions): at least one glomerulus with nodular increase in mesangial matrix (Kimmelstiel-Wilson) without changes described in class IV. Class IV, advanced diabetic glomerulosclerosis: more than 50% global glomerulosclerosis with other clinical or pathologic evidence that sclerosis is attributable to diabetic nephropathy. A good interobserver reproducibility for the four classes of DN was shown (intraclass correlation coefficient = 0.84) in a test of this classification.
尽管存在几种肾脏疾病的病理分类，包括 IgA 肾病、局灶节段性肾小球硬化和狼疮性肾炎，但缺乏统一的糖尿病肾病分类。我们的目标是受肾脏病理学会研究委员会的委托，制定一种将 1 型和 2 型糖尿病肾病结合起来的共识分类。这种分类应该能够区分不同严重程度的病变，以便在临床实践中易于在国际上使用。我们将糖尿病肾病分为四个层次的肾小球病变，并对间质和血管受累程度进行单独评估。被诊断为糖尿病肾病的活检标本分为以下几类：I 级，肾小球基底膜增厚：孤立性肾小球基底膜增厚，仅轻度、非特异性的光镜改变，不符合 II 级至 IV 级的标准。II 级，系膜扩张，轻度（IIa）或重度（IIb）：肾小球分类为轻度或重度系膜扩张，但没有结节性硬化（Kimmelstiel-Wilson 病变）或超过 50%的肾小球出现全球肾小球硬化。III 级，结节性硬化（Kimmelstiel-Wilson 病变）：至少一个肾小球系膜基质结节性增加（Kimmelstiel-Wilson），但没有描述的 IV 级改变。IV 级，晚期糖尿病性肾小球硬化：超过 50%的全球肾小球硬化，伴有其他临床或病理证据表明硬化归因于糖尿病肾病。对该分类的测试显示，DN 的四个等级具有良好的观察者间可重复性（组内相关系数=0.84）。
