日本 2 型糖尿病患者正常白蛋白尿和微量白蛋白尿的肾组织学异质性和功能进展。
Renal histological heterogeneity and functional progress in normoalbuminuric and microalbuminuric Japanese patients with type 2 diabetes.
机构信息
Health Care Center, Kitasato University , Sagamihara, Kanagawa , Japan.
Niigata University Health Administration Center , Niigata , Japan.
出版信息
BMJ Open Diabetes Res Care. 2014 Aug 8;2(1):e000029. doi: 10.1136/bmjdrc-2014-000029. eCollection 2014.
BACKGROUND AND OBJECTIVES
Renal histological injury patterns in type 2 diabetes are heterogeneous. We compared renal histological injury patterns using renal biopsy findings with renal function and followed up renal functional changes in normoalbuminuric and microalbuminuric patients with type 2 diabetes to determine whether renal function progresses according to injury patterns.
DESIGN SETTING PARTICIPANTS AND MEASUREMENTS
We examined 111 patients with type 2 diabetes with percutaneous renal biopsy (78 men, 52±11 years old, 59 normoalbuminuria, 52 microalbuminuria) and followed up 37 cases for 11 years. Light microscopy of tissues revealed renal injury patterns as: category I (CI), normal or near-normal structure; category II (CII), typical diabetic glomerulopathy; category III (CIII), atypical (disproportionately severe tubulointerstitial/vascular damage with no/mild glomerulopathy).
RESULTS
There were 29 CI, 62 CII, and 20 CIII patients. CII patients had a higher frequency of chronic kidney disease (CKD) G3-4, while the injury pattern distribution was not different among the albuminuria stages. The mean glomerular volume and volume fraction of cortical interstitium were larger than those of controls. The arteriolar hyalinosis index was larger in CII and CIII, while the percent global glomerular sclerosis was larger in CKD G3-4 compared with CKD G1-2. Renal function at follow-up was decreased in CII and CIII compared with the baseline estimated glomerular filtration rate (eGFR), while the GFR decline rate was faster in CII.
CONCLUSIONS
In normoalbuminuric and microalbuminuric patients with type 2 diabetes, loss of GFR could indicate typical diabetic glomerulosclerosis and a high frequency of global glomerular sclerosis. Urinary biomarkers identifying histological patterns of renal injury are necessary because GFR decline rates differed according to histological injury patterns.
背景与目的
2 型糖尿病的肾脏组织学损伤模式具有异质性。我们比较了肾活检结果与肾功能，并随访了 2 型糖尿病的正常白蛋白尿和微量白蛋白尿患者的肾功能变化，以确定根据损伤模式肾功能是否进展。
设计、设置、参与者和测量：我们检查了 111 例经皮肾活检的 2 型糖尿病患者（78 名男性，52±11 岁，59 名正常白蛋白尿，52 名微量白蛋白尿），并对 37 例患者进行了 11 年的随访。组织学的光镜检查显示肾脏损伤模式为：I 类（CI），正常或接近正常结构；II 类（CII），典型的糖尿病肾小球病变；III 类（CIII），非典型（肾小管间质/血管损伤不成比例严重，肾小球病变轻微/无）。
结果
29 例为 CI，62 例为 CII，20 例为 CIII。CII 患者慢性肾脏病（CKD）G3-4 的发生率较高，而在白蛋白尿阶段，损伤模式的分布无差异。肾小球体积和皮质间质体积分数均大于对照组。CII 和 CIII 的小动脉玻璃样变指数较大，而 CKD G3-4 的肾小球全球硬化比例较 CKD G1-2 大。与基线估算肾小球滤过率（eGFR）相比，CII 和 CIII 患者在随访时的肾功能下降，而 CII 的 GFR 下降速度较快。
结论
在 2 型糖尿病的正常白蛋白尿和微量白蛋白尿患者中，GFR 的丧失可能表明典型的糖尿病肾小球硬化和全球肾小球硬化的高频率。需要识别组织学损伤模式的尿生物标志物，因为根据组织学损伤模式，GFR 下降率不同。
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