Saito Y, Kida H, Takeda S, Yoshimura M, Yokoyama H, Koshino Y, Hattori N
First Department of Internal Medicine, School of Medicine, Kanazawa University, Ishikawa, Japan.
Kidney Int. 1988 Sep;34(3):389-96. doi: 10.1038/ki.1988.193.
In order to elucidate a participation of the mesangiolysis in the formation of diabetic nodular lesions, 355 kidney specimens obtained from 327 patients with primary diabetes mellitus were studied. Mesangiolyses begun by focal and segmental disintegration of the pivotal structure of the mesangium ("torn off phase"), resulting in cystic or aneurysmal dilatation of the involved tuft, were found in 56 specimens (16%). The dilated tufts were filled with lysed mesangial matrix, which showed a reticular or fibrillar arrangement ("structureless phase"), being followed by a concentrical re-arrangement ("reconstructive phase") and by the ultimate formation of diabetic nodules. The mesangiolysis of various phases was frequently found concomitant with severe diabetic arteriolosclerosis and, in the reconstructive phase, the lysed mesangial matrix near the recanalized capillary along the inner aspect of glomerular basement membrane was observed to be rearranged in a layered structure. These results suggest the hypothesis that: 1) the mesangiolysis is the initial lesion occurring in glomeruli in the process of diabetic nodule formation, and disturbed blood flow into glomeruli, caused by diabetic arteriolosclerosis, may be implicated in the development of the mesangiolysis; and 2) concentric compression of the lysed mesangial matrix by recanalized capillaries forms layered structures and ultimate completed diabetic nodules.
为阐明肾小球溶解在糖尿病结节性病变形成中的作用，对327例原发性糖尿病患者的355份肾脏标本进行了研究。在56份标本（16%）中发现了肾小球溶解，其始于肾小球系膜关键结构的局灶性和节段性崩解（“撕裂期”），导致受累肾小球小叶出现囊性或动脉瘤样扩张。扩张的肾小球小叶充满了溶解的系膜基质，呈网状或纤维状排列（“无结构期”），随后是同心重排（“重建期”），最终形成糖尿病结节。各阶段的肾小球溶解常与严重的糖尿病小动脉硬化同时出现，在重建期，观察到沿肾小球基底膜内侧再通毛细血管附近溶解的系膜基质重排成层状结构。这些结果提示如下假说：1）肾小球溶解是糖尿病结节形成过程中肾小球出现的初始病变，糖尿病小动脉硬化导致的肾小球血流紊乱可能与肾小球溶解的发生有关；2）再通毛细血管对溶解的系膜基质的同心压缩形成层状结构和最终完整的糖尿病结节。
