Li Xiao-Qian, Zheng Xin, Chen Min, Zhao Ming-Hui
Renal Division, Department of Medicine, Peking University First Hospital Peking University Institute of Nephrology Key Laboratory of Renal Disease, Ministry of Health of China Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
Medicine (Baltimore). 2017 May;96(18):e6805. doi: 10.1097/MD.0000000000006805.
The purpose of the current study was to investigate the characteristics of patients with diabetic nephropathy (DN) without diabetic retinopathy (DR).One hundred four patients with biopsy-proven DN, and 52 patients with diabetes mellitus (DM) without DR who were diagnosed as membranous nephropathy by renal biopsy were retrospectively included. We compared the clinical and laboratory parameters of DN patients with and without DR. Furthermore, among the DM patients without DR, we compared those with DN and with membranous nephropathy.Among patients with DN, including those with pure DN and DN coexisting with nondiabetic renal disease, compared with patients with DR, those without DR had significantly higher levels of serum albumin and hemoglobin (31.72 ± 7.97 vs 28.49 ± 6.30 g/L, P = .023; 128.11 ± 21.87 vs 113.06 ± 22.03 g/L, P = .001, respectively), and significantly lower level of serum creatinine and prevalence of diabetic neuropathy (148.56 ± 99.19 vs 203.75 ± 145.36 μmol/L, P = .028; 7.30% vs 32.70%, P = .001, respectively). Among patients with pure DN, compared with patients with DR, those without DR had significantly higher level of serum albumin (33.91 ± 5.79 vs 29.32 ± 5.42 g/L, P = .012). Among DM patients without DR, patients with membranous nephropathy had significantly lower levels of serum albumin and serum creatinine, and significantly higher levels of high-density lipoprotein and cholesterol than those with DN.In conclusion, DN patients without DR may have less serious renal damage and less diabetic complication than those with DR. In the absence of DR, there is still a lack of effective indicators suggesting diabetic nephropathy or nondiabetic glomerulopathy, and renal biopsy is indispensable for diagnosis in such circumstances.
本研究的目的是调查无糖尿病视网膜病变（DR）的糖尿病肾病（DN）患者的特征。回顾性纳入了104例经活检证实为DN的患者，以及52例无DR且经肾活检诊断为膜性肾病的糖尿病（DM）患者。我们比较了有DR和无DR的DN患者的临床和实验室参数。此外，在无DR的DM患者中，我们比较了DN患者和膜性肾病患者。在DN患者中，包括单纯DN患者和合并非糖尿病肾病的DN患者，与有DR的患者相比，无DR的患者血清白蛋白和血红蛋白水平显著更高（分别为31.72±7.97 vs 28.49±6.30 g/L，P = 0.023；128.11±21.87 vs 113.06±22.03 g/L，P = 0.001），血清肌酐水平和糖尿病神经病变患病率显著更低（分别为148.56±99.19 vs 203.75±145.36 μmol/L，P = 0.028；7.30% vs 32.70%，P = 0.001）。在单纯DN患者中，与有DR的患者相比，无DR的患者血清白蛋白水平显著更高（33.91±5.79 vs 29.32±5.42 g/L，P = 0.012）。在无DR的DM患者中，膜性肾病患者的血清白蛋白和血清肌酐水平显著更低，高密度脂蛋白和胆固醇水平显著更高。总之，无DR的DN患者可能比有DR的患者肾损害更轻，糖尿病并发症更少。在无DR的情况下，仍然缺乏提示糖尿病肾病或非糖尿病肾小球病的有效指标，在这种情况下肾活检对于诊断是必不可少的。
