Kalant N
Can Med Assoc J. 1978 Jul 22;119(2):146-53.
Current information on the nature, pathogenesis and treatment of diabetic glomerulosclerosis is reviewed. The fundamental lesion is one of the glomerular basement membrane, a complex layer of collage-like and other peptides; thickening of this membrane, seen microscopically, is due to the presence of an increased amount of membrane material of normal composition. There is little reliable evidence relating the frequency of glomerulosclerosis to the quality of control of the diabetic state, but indirect evidence from patients with secondary diabetes and from a variety of studies in animals indicates strongly that the glomerular lesion is a consequence of the abnormal metabolic state and can be prevented by adequate treatment of the diabetes. A concept of the pathogenesis of the glomerular lesions and renal failure is presented, but there remain large gaps in knowledge of the mechanisms involved. Treatment of chronic renal failure by maintenance renal dialysis and renal transplantation is not as successful in persons with diabetes as in those without this condition; however, the results appear to be improving, and transplantation particularly holds much promise.
本文综述了目前有关糖尿病肾小球硬化症的性质、发病机制及治疗的信息。基本病变发生于肾小球基底膜，这是一层由类胶原及其他肽类构成的复杂结构；镜下可见该膜增厚，是由于正常成分的膜物质数量增多所致。关于肾小球硬化症的发生频率与糖尿病病情控制质量之间的关系，几乎没有可靠证据，但来自继发性糖尿病患者及各种动物研究的间接证据有力表明，肾小球病变是异常代谢状态的结果，且可通过对糖尿病的充分治疗加以预防。文中提出了肾小球病变及肾衰竭发病机制的概念，但在相关机制的认识上仍存在很大差距。通过维持性肾透析和肾移植治疗慢性肾衰竭，在糖尿病患者中不如非糖尿病患者成功；不过，结果似乎正在改善，尤其是肾移植很有前景。
