Winetz J A, Golbetz H V, Spencer R J, Lee J A, Myers B D
Kidney Int. 1982 May;21(5):750-6. doi: 10.1038/ki.1982.93.
Intrinsic membrane properties of the glomerular capillary wall were evaluated in 20 diabetic patients, who had heavy proteinuria and reduced GFR, and in 15 healthy control subjects. The glomerular sieving coefficients were determined for narrow dextran fractions with molecular radii between 20 and 64 A. GFR determinants were directly measured or indirectly estimated. These quantities were then subjected to a theoretical analysis based upon (1) a mathematical model of glomerular ultrafiltration and (2) a pore model of transmembrane solute transport. The results indicated that in patients with diabetic nephropathy and glomerular ultrafiltration coefficient (0.02 vs. 0.16 ml . sec-1 . mm Hg-1 . 1.73m-2), effective pore area-to-pore length (2.6 x 10(6) vs. 20.0 x 10(6) cm), and mean pore radius (56.8 vs. 58.0 A) are all reduced relative to normal control subjects. It is suggested that (1) hypofiltration in advanced diabetic nephropathy results, in part, from reduction of the surface area available for filtration, while (2) proteinuria is a consequence of either loss of electrostatic barrier function, of isolated focal disruptions within the glomerular filtration barrier, or a combination thereof.
对20例患有大量蛋白尿和肾小球滤过率（GFR）降低的糖尿病患者以及15名健康对照者的肾小球毛细血管壁的内在膜特性进行了评估。测定了分子半径在20至64埃之间的窄葡聚糖级分的肾小球筛分系数。直接测量或间接估计GFR的决定因素。然后根据（1）肾小球超滤的数学模型和（2）跨膜溶质转运的孔模型对这些量进行理论分析。结果表明，糖尿病肾病患者的肾小球超滤系数（0.02对0.16 ml·sec-1·mmHg-1·1.73m-2）、有效孔面积与孔长度之比（2.6×10(6)对20.0×10(6) cm）以及平均孔半径（56.8对58.0埃）相对于正常对照者均降低。提示（1）晚期糖尿病肾病中的低滤过部分是由于可用于滤过的表面积减少所致，而（2）蛋白尿是静电屏障功能丧失、肾小球滤过屏障内孤立的局灶性破坏或两者共同作用的结果。
