Kleinman K S, Fine L G
Department of Medicine, UCLA School of Medicine 90024.
Diabetes Metab Rev. 1988 Mar;4(2):179-89. doi: 10.1002/dmr.5610040207.
Early in the course of type 1 diabetes mellitus, hypertrophy of the kidney is a consistent finding that is easily diagnosed using current noninvasive methods, especially ultrasonography. Renal functional changes occur in association with hypertrophy, most notably glomerular hyperfiltration. The structural counterpart of this functional change is an early increase in capillary filtration surface area. In most forms of nondiabetic renal hypertrophy, kidney size is closely linked to GFR. In contrast, in diabetes, persistence of hypertrophy after the clinical onset of overt kidney disease (microalbuminuria, hypertension, decreased GFR, etc.) suggests that sustained release of one or more growth factors may continue even after kidney function declines. The fact that growth factors can act in both an autocrine and paracrine fashion raises the possibility that the local effects of such substances may act as local mediators of kidney growth. Failure of renal hypertrophy to reverse following strict glycemic control for a few months may turn out to be an important prognostic indicator of future progression of the renal disease, but this remains to be established. Prospective studies of kidney size in patients with newly diagnosed type 1 diabetes, using accurate noninvasive methods, may be helpful in establishing whether irreversible ("autonomous") hypertrophy of the kidney is indeed a useful prognostic indicator. As therapies are developed that target the different microvascular complications of diabetes (retinopathy, nephropathy, neuropathy), a noninvasive estimation of kidney size may be a cost-effective method of predicting ultimate renal involvement. Since microalbuminuria occurs relatively late in the disease process, early and persistent hypertrophy of the kidney may become a useful prognostic test in the earliest stages of the disease.
在1型糖尿病病程早期，肾脏肥大是一个常见的表现，使用当前的非侵入性方法，尤其是超声检查，很容易诊断出来。肾功能改变与肾脏肥大相关，最显著的是肾小球高滤过。这种功能改变的结构对应物是毛细血管滤过表面积早期增加。在大多数非糖尿病性肾脏肥大形式中，肾脏大小与肾小球滤过率密切相关。相比之下，在糖尿病中，显性肾病（微量白蛋白尿、高血压、肾小球滤过率降低等）临床发病后肾脏肥大持续存在，这表明即使肾功能下降，一种或多种生长因子的持续释放可能仍在继续。生长因子可通过自分泌和旁分泌方式发挥作用，这增加了此类物质的局部作用可能作为肾脏生长局部介质的可能性。严格血糖控制数月后肾脏肥大未能逆转，可能会成为肾脏疾病未来进展的一个重要预后指标，但这一点仍有待确定。对新诊断的1型糖尿病患者使用准确的非侵入性方法进行肾脏大小的前瞻性研究，可能有助于确定肾脏不可逆（“自主性”）肥大是否确实是一个有用的预后指标。随着针对糖尿病不同微血管并发症（视网膜病变、肾病、神经病变）的治疗方法的开发，肾脏大小的非侵入性估计可能是预测最终肾脏受累情况的一种经济有效的方法。由于微量白蛋白尿在疾病过程中出现相对较晚，肾脏早期和持续性肥大可能会成为疾病最早阶段一个有用的预后检测方法。
