Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan.
Am J Hypertens. 2019 Aug 14;32(9):900-908. doi: 10.1093/ajh/hpz059.
Diabetes and hypertension share renal histopathological features, such as arterial lesions and glomerular hypertrophy, that have not been investigated in relation to the blood pressure status of diabetic subjects. The severity of glomerular lesions varies across locations of the renal cortex, which may be further affected by diabetes and/or hypertension.
Histopathological lesions in different parts of the renal cortex of autopsy kidneys were evaluated and analyzed based on medical histories of diabetes and hypertension.
This study included a total of 82 Japanese autopsies composed of normotensive nondiabetics (n = 31), hypertensive nondiabetics (n = 28), normotensive diabetics (n = 14), and hypertensive diabetics (n = 9). There were no differences in age, sex, renal function, or body size among groups. In both the superficial and juxtamedullary cortices, increased glomerular volume (GV) was significantly associated with either diabetes or hypertension. In addition, diabetes and hypertension showed a significant interaction with GV regardless of the cortical location. Values for global glomerulosclerosis (GGS) and arteriolar hyalinosis (AH) were associated with diabetes but not with hypertension. Only values for GGS consistently showed cortical surface superiority. The zonal distribution of AH, GV, or other diabetic glomerular lesions differed among the lesions depending on the presence or absence of hypertension.
These results imply that diabetes and hypertension synergistically enhance glomerular hypertrophy across all layers of the human renal cortex. The process is closely associated with the severity of GGS and AH predominantly associated with diabetes.
糖尿病和高血压具有共同的肾脏组织病理学特征，例如动脉病变和肾小球肥大，这些特征尚未在糖尿病患者的血压状况下进行研究。肾小球病变的严重程度在肾皮质的不同部位有所不同，这可能进一步受到糖尿病和/或高血压的影响。
根据糖尿病和高血压的病史，评估和分析尸检肾脏皮质不同部位的组织病理学病变。
本研究共纳入 82 例日本尸检病例，包括血压正常的非糖尿病患者（n = 31）、高血压非糖尿病患者（n = 28）、血压正常的糖尿病患者（n = 14）和高血压糖尿病患者（n = 9）。各组之间的年龄、性别、肾功能或体型均无差异。在皮质浅层和近髓质层，肾小球体积（GV）的增加与糖尿病或高血压均显著相关。此外，无论皮质位置如何，糖尿病和高血压与 GV 均显示出显著的相互作用。全球肾小球硬化（GGS）和小动脉玻璃样变（AH）的数值与糖尿病相关，但与高血压无关。只有 GGS 的数值始终表现出皮质表面优势。AH、GV 或其他糖尿病肾小球病变的区域分布因是否存在高血压而在病变之间有所不同。
这些结果表明，糖尿病和高血压协同作用增强了人类肾皮质各层的肾小球肥大。这一过程与 GGS 和 AH 的严重程度密切相关，AH 主要与糖尿病相关。
