Department of Analytic Human Pathology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan.
Department of Nephrology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Hum Pathol. 2018 May;75:95-103. doi: 10.1016/j.humpath.2018.01.019. Epub 2018 Feb 2.
The Renal Pathology Society proposed a pathological classification for diabetic nephropathy (DN) (RPS 2010). We retrospectively examined the renal structural-functional relationships using the RPS 2010 classification in 49 DN cases. We also evaluated the importance of the percentage of glomeruli with nodular diabetic glomerulosclerosis and their morphological characteristics (cellular, cellular and extracellular matrix [ECM] or ECM types) in the pathology of DN. The classes of DN (RPS 2010) were significantly correlated with the duration of diabetes mellitus (DM), degree of proteinuria, a decreased estimated glomerular filtration rate (eGFR), and the stages of Japanese clinical DM and chronic kidney disease (CKD). When the percentage of glomeruli with nodular glomerulosclerosis (IIIA <25%, IIIB 25-50%, IIIC 50-75%, and IIID >75%) was added to class III in this classification, the classes of DN had a greater correlation with the levels of proteinuria. The morphological characteristics of nodular glomerulosclerosis such as cellular, cellular and ECM, or ECM type were associated with several clinical parameters including the duration of DM, degree of proteinuria, a decreased eGFR, and/or the stages of clinical DM and CKD. Mesangial red blood cell fragments that is indicative of microvascular injury was found in cellular or cellular and ECM types of nodular glomerulosclerosis. The RPS 2010 classification is useful as a DN pathological classification that indicates a good correlation with the clinical characteristics of DN. In addition, the frequency and morphological characteristics of nodular diabetic glomerulosclerosis is important for the evaluation of the pathology in DN.
肾脏病理学会（Renal Pathology Society，RPS）提出了一种糖尿病肾病（DN）的病理分类（RPS 2010）。我们回顾性地使用 RPS 2010 分类检查了 49 例 DN 病例的肾脏结构-功能关系。我们还评估了结节性糖尿病肾小球硬化症肾小球的比例及其形态特征（细胞型、细胞-细胞外基质[ECM]型或 ECM 型）在 DN 病理中的重要性。DN（RPS 2010）的分类与糖尿病病程（DM）、蛋白尿程度、估算肾小球滤过率（eGFR）降低以及日本临床 DM 和慢性肾脏病（CKD）分期显著相关。当结节性肾小球硬化症肾小球的比例（IIIA<25%、IIIB 25-50%、IIC 50-75%和 IID>75%）加入到该分类的 III 类时，DN 的分类与蛋白尿水平的相关性更大。结节性肾小球硬化症的形态特征，如细胞型、细胞-细胞外基质型或 ECM 型，与多个临床参数相关，包括 DM 病程、蛋白尿程度、eGFR 降低和/或临床 DM 和 CKD 分期。在细胞型或细胞-细胞外基质型结节性肾小球硬化症中发现了提示微血管损伤的系膜红细胞碎片。RPS 2010 分类是一种有用的 DN 病理分类，与 DN 的临床特征具有良好的相关性。此外，结节性糖尿病肾小球硬化症的频率和形态特征对于评估 DN 的病理具有重要意义。
