Banholzer P, Haslbeck M, Edelmann E, Sager P, Staudigl K, Mehnert H
Forschergruppe Diabetes, III. Medizinische Abteilung, Städtisches Krankenhaus München-Schwabing.
Ultraschall Med. 1988 Dec;9(6):255-9. doi: 10.1055/s-2007-1011639.
We carried out sonographic examination of 160 type I diabetics measuring the renal volume, the parenchyma/renal pelvis index and the brightness of the parenchyma. Creatinine and beta-2-microglobulin in the serum, creatinine clearance and albumin excretion by urine were determined as functional parameters. In contrast to existing results, we were unable to find significant changes in kidney size or function in newly diagnosed diabetics (duration of diabetes up to 6 months). Both the parenchyma/renal pelvis index and the kidney parenchyma were unchanged compared to control persons of the same age. It was only if diabetes lasted from 6 months to 5 years, that the renal volume was 19% larger (192 +/- 37 cm3/1.73 m2) than that of recently diagnosed patients (p less than 0.01). The index had increased by 15%, whereas the creatinine clearance had increased by 18% to 121 +/- 27 ml/min as a result of increased perfusion. The renal volume decreased continuously over a five-year period of duration of diabetes. Initially, microalbuminuria became manifest, followed some time later by a decrease in creatinine clearance and a corresponding increase in creatinine and beta-2-microglobulin in serum. No change in parenchyma brightness was noted. Diabetics with moderate renal insufficiency (creatinine 1.2 to 2 mg/dl) compared to diabetics without insufficiency developed larger kidneys (207 cm3/1.73 m2; p less than 0.01). Only in case of severe insufficiency (creatinine greater than 2 mg/dl) did the kidneys did shrink significantly (121 cm3/1,73 m2, n = 8, p less than 0.01). The temporary enlargement of the kidneys could be a prognostically unfavourable sign pointing towards a developing diabetic nephropathy.
我们对160例I型糖尿病患者进行了超声检查，测量了肾脏体积、实质/肾盂指数以及肾实质的亮度。测定血清中的肌酐和β2 -微球蛋白、肌酐清除率以及尿白蛋白排泄量作为功能参数。与现有结果不同的是，我们在新诊断的糖尿病患者（糖尿病病程长达6个月）中未发现肾脏大小或功能有显著变化。与同龄对照组相比，实质/肾盂指数和肾实质均无变化。仅当糖尿病病程持续6个月至5年时，肾脏体积比近期诊断的患者大19%（192±37 cm³/1.73 m²）（p<0.01）。该指数增加了15%，而由于灌注增加，肌酐清除率增加了18%，达到121±27 ml/min。在糖尿病病程的五年期间，肾脏体积持续下降。最初出现微量白蛋白尿，一段时间后肌酐清除率下降，血清中的肌酐和β2 -微球蛋白相应增加。肾实质亮度未见变化。与无肾功能不全的糖尿病患者相比，中度肾功能不全（肌酐1.2至2 mg/dl）的糖尿病患者肾脏更大（207 cm³/1.73 m²；p<0.01）。仅在严重肾功能不全（肌酐>2 mg/dl）的情况下，肾脏才会显著缩小（121 cm³/1.73 m²，n = 8，p<0.01）。肾脏的暂时增大可能是糖尿病肾病发展的一个预后不良迹象。
