Health Care Center, Kitasato University, Sagamihara, Kanagawa, Japan
Omura Clinic, Shizuoka, Shizuoka, Japan.
Diabetes Care. 2017 Oct;40(10):1373-1378. doi: 10.2337/dc17-0209. Epub 2017 Aug 3.
This study investigated the association between renal histology, as assessed by morphometric analysis using light (LM) and electron (EM) microscopy, and changes in urinary albumin excretion (UAE) and glomerular filtration rate (GFR) in Japanese people with type 2 diabetes in the early stages of diabetic nephropathy.
We performed percutaneous renal biopsies in 29 patients with type 2 diabetes (22 men, mean ± SD age 49 ± 10 years and GFR 119 ± 27 mL/min/1.73 m, with 15 normoalbuminuric [UAE <20 μg/min] and 14 microalbuminuric [UAE 20-200 μg/min]) to clarify which histological factors were associated with changes in UAE and GFR during 8.0 ± 3.5 years' follow-up. Glomerular structural changes including mesangial volume fraction [Vv(Mes/glom)] were estimated using EM, whereas the index of arteriolar hyalinosis (IAH) score was assessed by LM. Patients underwent annual measurement of GFR using iohexol injection with simultaneous urine collections for UAE.
Vv(Mes/glom) was negatively correlated with baseline and follow-up GFR but not with UAE. The IAH score was positively correlated with UAE and negatively correlated with GFR at follow-up, but it was not correlated with either UAE or GFR at baseline. GFR at follow-up was significantly decreased from baseline in patients with IAH scores ≥2.0 and significantly lower than in patients with IAH scores <2.0. Patients with IAH scores <2.0 showed no significant change in GFR during follow-up.
Arteriolar hyalinosis is an additional histological predictor for albuminuria increase and GFR decline in normo- and microalbuminuric Japanese people with type 2 diabetes.
本研究旨在探讨日本 2 型糖尿病早期糖尿病肾病患者的肾脏组织学改变（通过光镜和电镜下的形态计量分析评估）与尿白蛋白排泄率（UAE）和肾小球滤过率（GFR）变化之间的关系。
我们对 29 例 2 型糖尿病患者（22 例男性，平均年龄 ± 标准差为 49 ± 10 岁，GFR 为 119 ± 27 mL/min/1.73 m，其中 15 例为正常白蛋白尿[UAE <20 μg/min]，14 例为微量白蛋白尿[UAE 20-200 μg/min]）进行了经皮肾活检，以明确哪些组织学因素与 8.0 ± 3.5 年随访期间 UAE 和 GFR 的变化有关。使用电镜评估肾小球结构变化，包括系膜体积分数[Vv（Mes/glom）]，而通过光镜评估小动脉玻璃样变指数（IAH）评分。患者每年接受 iohexol 注射测定 GFR，同时收集尿液测定 UAE。
Vv（Mes/glom）与基线和随访时的 GFR 呈负相关，但与 UAE 无关。IAH 评分与 UAE 呈正相关，与随访时的 GFR 呈负相关，但与基线时的 UAE 或 GFR 均无关。IAH 评分≥2.0 的患者随访时的 GFR 明显低于基线，明显低于 IAH 评分<2.0 的患者。IAH 评分<2.0 的患者在随访期间 GFR 无明显变化。
小动脉玻璃样变是日本 2 型糖尿病正常和微量白蛋白尿患者白蛋白尿增加和 GFR 下降的另一个组织学预测因素。
