Penescu M, Mandache E
Department of Nephropathology, Carol Davila Clinical Hospital for Nephropathology, Bucharest, Romania.
Rom J Morphol Embryol. 2010;51(1):13-9.
The purpose of this work is to emphasize the value of kidney biopsy in patients with diabetes mellitus and clinical renal impairment. Diabetes is the leading cause of end stage renal disease because diabetic nephropathy develops in 30 to 40% of patients. Multiple genetic predisposing conditions are involved in the development or not of a diabetic nephropathy, therefore supporting the existence of several factors in the pathogenesis of this disease. These predisposing conditions may also favor different other types of glomerulonephritis which can occur independently or in parallel with a diabetic nephropathy. All these renal diseases have different treatments, and therefore they must be correctly identified and managed accordingly. The processing of the kidney biopsy samples requires a very careful and highly qualified management to differentiate precisely the nature of each condition. In addition to the mesangial classical lesions, recent biopsy studies provided evidence that podocytes are injured very early in the diabetic nephropathy. On the other hand, transgenic mice models provide a unique opportunity to investigate the natural course of the disease. The paper underlines the main laboratory techniques required for this activity, and the main structural arguments to perform a satisfactory differential diagnosis.
这项工作的目的是强调肾活检在糖尿病合并临床肾功能损害患者中的价值。糖尿病是终末期肾病的主要病因，因为30%至40%的患者会发生糖尿病肾病。多种遗传易感性因素参与糖尿病肾病的发生与否，因此支持该疾病发病机制中存在多种因素。这些易感性因素也可能有利于其他不同类型的肾小球肾炎，这些肾小球肾炎可独立发生或与糖尿病肾病同时发生。所有这些肾脏疾病都有不同的治疗方法，因此必须正确识别并相应地进行管理。肾活检样本的处理需要非常仔细且高素质的管理，以精确区分每种情况的性质。除了系膜经典病变外，最近的活检研究表明，足细胞在糖尿病肾病早期就会受到损伤。另一方面，转基因小鼠模型为研究该疾病的自然病程提供了独特的机会。本文强调了这项活动所需的主要实验室技术，以及进行满意的鉴别诊断的主要结构依据。
