Herf S, Pohl S L, Sturgill B, Bolton W K
Am J Med. 1979 Jun;66(6):1040-5. doi: 10.1016/0002-9343(79)90462-5.
Diabetic glomerulosclerosis must be either a primary manifestation or a secondary consequence of the metabolic abnormalities of diabetes. Several earlier reports have attempted to support the former hypothesis by describing cases of pathognomonic renal lesions in nondiabetic subjects; however, the clinical and pathologic data in these reports are inconclusive. We have reviewed our experience at the University of Virginia Hospital with 447 percutaneous renal biopsies performed over a period of four years from July 1973 through July 1977. Of these cases, only two appeared to represent diabetic glomerulosclerosis occurring in nondiabetic subjects. Upon further investigation, one case provided to be light chain disease demonstrated by immunofluorescence staining. The other case, on repeat renal biopsy, proved to be membranoproliferative glomerulonephritis. We conclude that a diagnosis of diabetic glomerulosclerosis must be viewed with suspicion in nondiabetic subjects. Suspected cases should be labeled pseudodiabetic glomerulosclerosis and investigated further.
糖尿病性肾小球硬化症必定是糖尿病代谢异常的主要表现或次要后果。一些早期报告试图通过描述非糖尿病患者中具有特征性肾脏病变的病例来支持前一种假设；然而，这些报告中的临床和病理数据尚无定论。我们回顾了弗吉尼亚大学医院在1973年7月至1977年7月这四年期间进行的447例经皮肾活检的经验。在这些病例中，只有两例似乎代表非糖尿病患者发生的糖尿病性肾小球硬化症。经过进一步调查，其中一例经免疫荧光染色证实为轻链病。另一例在重复肾活检时被证明是膜增生性肾小球肾炎。我们得出结论，对于非糖尿病患者，糖尿病性肾小球硬化症的诊断必须谨慎对待。疑似病例应标记为假性糖尿病性肾小球硬化症并进一步调查。
