Department of Medicine, Clinica Medica 3, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
Department of Pediatrics and Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
J Nephrol. 2020 Oct;33(5):901-907. doi: 10.1007/s40620-020-00797-y. Epub 2020 Jul 12.
The clinical manifestations of diabetic nephropathy are similar in type 1 and type 2 diabetes, while the renal lesions may differ. Indeed, diabetic glomerulopathy is the predominant renal lesion in type 1 diabetes, although also tubular, interstitial and arteriolar lesions are present in the advanced stages of renal disease. In contrast, in type 2 diabetes renal lesions are heterogeneous, and a substantial number of type 2 diabetic patients with diabetic kidney disease have mild or absent glomerulopathy with tubulointerstitial and/or arteriolar abnormalities. In addition, a high prevalence of non-diabetic renal diseases, isolated or superimposed on classic diabetic nephropathy lesions have been reported in patients with type 2 diabetes, often reflecting the bias of selecting patients for unusual clinical presentations for renal biopsy. This review focuses on renal structural changes in type 2 diabetes, emphasizing the contribution of research kidney biopsy studies to the understanding of the pathogenesis of DKD and of the structural lesions responsible for the different clinical phenotypes. Also, kidney biopsies could provide relevant information in terms of renal prognosis, and help to understand the different responses to different therapies, especially SGLT2 inhibitors, thus allowing personalized medicine.
糖尿病肾病的临床表现在 1 型和 2 型糖尿病中相似，而肾脏病变可能不同。实际上，在 1 型糖尿病中，糖尿病肾小球病变是主要的肾脏病变，尽管在肾脏病的晚期也存在肾小管、间质和小动脉病变。相比之下，在 2 型糖尿病中，肾脏病变是异质性的，并且相当数量的 2 型糖尿病伴糖尿病肾病患者的肾小球病变较轻或不存在，伴有肾小管间质和/或小动脉异常。此外，在 2 型糖尿病患者中，已经报道了非糖尿病性肾脏疾病的高发，这些疾病单独存在或叠加在经典的糖尿病肾病病变上，这通常反映了为肾脏活检选择不常见临床表现的患者的偏倚。这篇综述重点关注 2 型糖尿病的肾脏结构变化，强调研究性肾脏活检研究对理解 DKD 的发病机制以及导致不同临床表型的结构病变的贡献。此外，肾脏活检可以提供有关肾脏预后的相关信息，并有助于了解对不同治疗方法的不同反应，特别是 SGLT2 抑制剂，从而实现个体化治疗。
