Kelly K J, Dominguez Jesus H
Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind., USA.
Am J Nephrol. 2010;32(5):469-75. doi: 10.1159/000320749. Epub 2010 Oct 19.
BACKGROUND/AIMS: Chronic kidney disease (CKD) from diabetic nephropathy is characterized by progressive loss of renal function. The renal decline has been viewed as a linear fall, presumably dependent on metabolic, hemodynamic and dietary stresses. However, renal injury in diabetic nephropathy can be rapidly aggravated by unpredictable external and internal factors, a state of affairs inconsistent with a linear loss of function. Acute renal injury and subsequent inflammation are potential factors, and we investigated their presence in renal biopsies from patients with nephropathy.
In a protocol approved by the Indiana University School of Medicine Institutional Review Board, renal biopsy specimens, estimated GFR, proteinuria and renal survival were examined in patients with diabetic nephropathy.
Prominent clusters of inflammatory cells, particularly macrophages, were detected in the renal biopsy specimens. CKD progressed rapidly but not linearly, in that CKD was characterized by a succession of seemingly random episodes of self-limited acute renal failure. Episodes of acute kidney injury were associated with progression to end-stage renal disease.
We propose that diabetic nephropathy is complicated by unpredictable and possibly random episodes of usually self-limited acute renal failure, and by subsequent renal inflammation, which appear to accelerate progression and eventual kidney loss.
背景/目的：糖尿病肾病所致的慢性肾脏病（CKD）的特征是肾功能进行性丧失。肾功能下降一直被视为呈线性下降，推测与代谢、血流动力学和饮食压力有关。然而，糖尿病肾病中的肾损伤可因不可预测的外部和内部因素而迅速加重，这种情况与功能的线性丧失不一致。急性肾损伤及随后的炎症是潜在因素，我们研究了它们在肾病患者肾活检中的存在情况。
在印第安纳大学医学院机构审查委员会批准的一项方案中，对糖尿病肾病患者的肾活检标本、估计的肾小球滤过率、蛋白尿和肾脏存活率进行了检查。
在肾活检标本中检测到显著的炎症细胞簇，尤其是巨噬细胞。CKD进展迅速但并非呈线性，因为CKD的特征是一系列看似随机的自限性急性肾衰竭发作。急性肾损伤发作与进展至终末期肾病相关。
我们提出，糖尿病肾病并发通常为自限性的急性肾衰竭的不可预测且可能随机的发作，以及随后的肾脏炎症，这似乎会加速疾病进展并最终导致肾脏丧失。
