Department of Nephrology, Tokyo Medical University, Tokyo, Japan.
Nephrology (Carlton). 2012 Jan;17(1):68-75. doi: 10.1111/j.1440-1797.2011.01525.x.
Although several clinical risk factors for end-stage renal disease in diabetic nephropathy are known, the pathological findings that may help predict renal prognosis have not yet been defined.
We enrolled 69 diabetes mellitus type 2 patients with overt proteinuria and biopsy-confirmed diabetic nephropathy with mesangial expansion, and retrospectively examined the association of histological and clinical findings with renal outcome. The median follow-up duration was 52 months. Histological scoring was made according to that of Tervaert et al. Patients were divided into four groups according to glomerular classification (class 2a, mild mesangial expansion, n=11; class 2b, severe mesangial expansion without nodular sclerosis, n=15; class 3, nodular sclerosis, n=36; class 4, global glomerulosclerosis observed in more than 50% of glomeruli, n=7). Interstitial and vascular lesions were scored for each patient. A renal event was defined as a condition requiring the initiation of chronic dialysis or doubling of the serum creatinine level.
Cox proportional hazard analysis showed that the glomerular classes were not significant variables, while interstitial fibrosis, tubular atrophy and interstitial inflammation were independent variables associated with renal end-point (HR: 3.36 (95% confidence interval: 1.21-9.32), 4.74 (1.26-17.91)). There were no significant differences in the renal survival rates between the glomerular classes 2a and 2b combined group and the glomerular class 3 group (P=0.17, log-rank test).
Interstitial lesions but not glomerular lesions were a significant predictor for renal prognosis in diabetic nephropathy in type 2 diabetes patients with overt proteinuria.
尽管已知一些糖尿病肾病终末期肾病的临床危险因素，但尚未确定有助于预测肾脏预后的病理发现。
我们纳入了 69 名患有显性蛋白尿和经活检证实的伴有系膜扩张的糖尿病肾病的 2 型糖尿病患者，并回顾性地检查了组织学和临床发现与肾脏结局的关系。中位随访时间为 52 个月。组织学评分根据 Tervaert 等人的评分进行。根据肾小球分类（2a 级，轻度系膜扩张，n=11；2b 级，严重系膜扩张但无结节性硬化，n=15；3 级，结节性硬化，n=36；4 级，肾小球硬化超过 50%的肾小球，n=7）将患者分为四组。对每位患者的间质和血管病变进行评分。肾脏事件定义为需要开始慢性透析或血清肌酐水平加倍的情况。
Cox 比例风险分析显示肾小球分类不是显著变量，而间质纤维化、肾小管萎缩和间质炎症是与肾脏终点相关的独立变量（HR：3.36（95%置信区间：1.21-9.32），4.74（1.26-17.91））。肾小球 2a 和 2b 联合组与肾小球 3 级组之间的肾脏存活率没有显著差异（P=0.17，对数秩检验）。
在伴有显性蛋白尿的 2 型糖尿病患者的糖尿病肾病中，间质病变而不是肾小球病变是肾脏预后的重要预测因素。
