Schwieger J, Fine L G
Department of Medicine, UCLA School of Medicine 90024.
Semin Nephrol. 1990 May;10(3):242-53.
In early type 1 diabetes mellitus, hypertrophy of the kidney is a consistent finding. It is easily diagnosed using current noninvasive methods, especially ultrasonography. Renal functional changes occur in association with hypertrophy, most notably glomerular hyperfiltration. The structural counterpart of this functional change is an early increase in capillary filtration surface area. In most forms of nondiabetic renal hypertrophy, kidney size is closely linked to GFR, but in diabetes, hypertrophy persists after the clinical onset of overt kidney disease (microalbuminuria, hypertension, decreased GFR, etc). The fact that growth factors produced by the kidney can act in both an autocrine and paracrine fashion raises the possibility that the local effects of such substances may act as local mediators of kidney growth, but no such factor has been identified as the initiating or sustaining factor in diabetic hypertrophy. Failure of renal hypertrophy to reverse following strict glycemic control for a few months may turn out to be an important prognostic indicator of future progression of the renal disease, but this remains to be studied in a large group of patients.
在1型糖尿病早期，肾脏肥大是一个常见的表现。使用当前的非侵入性方法，尤其是超声检查，很容易诊断出肾脏肥大。肾功能变化与肾脏肥大相关，最显著的是肾小球高滤过。这种功能变化的结构对应物是毛细血管滤过表面积的早期增加。在大多数非糖尿病性肾肥大形式中，肾脏大小与肾小球滤过率密切相关，但在糖尿病中，在明显肾脏疾病（微量白蛋白尿、高血压、肾小球滤过率降低等）临床发病后，肾脏肥大仍持续存在。肾脏产生的生长因子可通过自分泌和旁分泌方式发挥作用，这一事实增加了此类物质的局部作用可能作为肾脏生长的局部介质的可能性，但尚未确定此类因子是糖尿病性肥大的起始或持续因子。严格血糖控制数月后肾脏肥大未能逆转，可能成为肾脏疾病未来进展的重要预后指标，但这仍有待在大量患者中进行研究。
