Halmai Richárd, Degrell Péter, Szijártó István András, Mátyás Viktória, Molnár Gergå Attila, Kovács Tibor, Wittmann István
2nd Department of Internal Medicine and Nephrological Center, University of Pecs, Pecs, Hungary.
Clin Nephrol. 2013 Jul;80(1):23-8. doi: 10.5414/CN107812.
The histological pattern of nodular glomerulosclerosis (NGS) can be found both in diabetic nephropathy (Kimmelstiel-Wilson (KW) lesion) and non-diabetic nodular glomerulosclerosis (non-diab NGS). Chronic smoking is considered to be a potential cause of non-diab NGS, but the prevalence of smokers in KW is unknown.
In a retrospective analysis, native renal biopsy specimens (n = 644, 2001 - 2011) were evaluated and male patients' characteristics, including smoking habits, were assessed within three groups: diabetic patients with KW (n = 15), diabetic patients with other classes of diabetic nephropathy (non-KW; n = 46), and patients with non-diab NGS (n = 7).
The majority of patients in the KW and non-diab NGS groups (13/15 = 87%, 7/7 = 100%, respectively; p = 1.0 vs. KW) were smokers, unlike the non-KW group (16/46 = 35%; p = 0.001 vs. KW). Cigarette pack-years showed a similar pattern (KW: 15 (6 - 30), non-KW: 0 (0 - 21), non-diab NGS: 30 (16 - 33); p = 0.010 non-KW vs. KW, p = 0.008 non-KW vs. non-diab NGS). Other known factors responsible for the worsening of non-KW or the development of non-diab NGS did not differ in the groups (age, body mass index, duration of diabetes mellitus, HbA1c, prevalence of hypertension, duration of hypertension, serum cholesterol, triglyceride, estimated glomerular filtration rate, and renin-angiotensin-aldosteron system-blocker treatment).
We propose that chronic cigarette smoking could play a pivotal role in the development of KW lesions.
结节性肾小球硬化（NGS）的组织学模式可见于糖尿病肾病（金梅尔施泰因 - 威尔逊（KW）病变）和非糖尿病性结节性肾小球硬化（非糖尿病性NGS）。长期吸烟被认为是非糖尿病性NGS的一个潜在病因，但KW患者中吸烟者的比例尚不清楚。
在一项回顾性分析中，对2001年至2011年期间的644份肾活检标本进行评估，并在三组中评估男性患者的特征，包括吸烟习惯：患有KW的糖尿病患者（n = 15）、患有其他类型糖尿病肾病（非KW；n = 46）的糖尿病患者以及患有非糖尿病性NGS的患者（n = 7）。
KW组和非糖尿病性NGS组的大多数患者（分别为13/15 = 87%，7/7 = 100%；与KW组相比，p = 1.0）是吸烟者，这与非KW组不同（16/46 = 35%；与KW组相比，p = 0.001）。吸烟包年数呈现相似模式（KW组：15（6 - 30），非KW组：0（0 - 21），非糖尿病性NGS组：30（16 - 33）；非KW组与KW组相比，p = 0.010，非KW组与非糖尿病性NGS组相比，p = 0.008）。其他已知的导致非KW病情恶化或非糖尿病性NGS发生的因素在各组中无差异（年龄、体重指数、糖尿病病程、糖化血红蛋白、高血压患病率、高血压病程、血清胆固醇、甘油三酯、估计肾小球滤过率以及肾素 - 血管紧张素 - 醛固酮系统阻滞剂治疗）。
我们认为长期吸烟可能在KW病变的发生中起关键作用。
