Chobanian M C, Chevalier R L, Sturgill B C, Bolton W K
Int J Pediatr Nephrol. 1984 Mar;5(1):23-9.
The onset of fixed proteinuria and hypertension in insulin-dependent diabetic is generally associated with eventual renal insufficiency due to diabetic nephropathy or with a superimposed glomerulopathy. We report three adolescents with normal renal function who developed fixed proteinuria and hypertension after only 7 to 11 years of insulin-dependent diabetes mellitus. Blood pressure ranged from 130/95 to 165/104 mmHg, urinary protein excretion was 1.31 to 1.37 g/24 hours, and creatinine clearance ranged from 98-133 ml/min/1.73 m2. Renal biopsy revealed changes consistent only with diabetic glomerulosclerosis. Follow-up evaluation for 11 months to 3 1/2 years revealed blood pressure reductions to 125/78-140/85 mmHg as a result of antihypertensive medications. Creatinine clearance increased by 12-20% and urinary protein excretion remained unchanged. We conclude that these patients may represent an unusual subgroup of insulin-dependent diabetics with early development of clinical and pathological diabetic nephropathy in the face of normal renal function.
胰岛素依赖型糖尿病患者出现持续性蛋白尿和高血压通常与糖尿病肾病最终导致的肾功能不全或合并的肾小球病变有关。我们报告了三名肾功能正常的青少年，他们在仅患胰岛素依赖型糖尿病7至11年后就出现了持续性蛋白尿和高血压。血压范围为130/95至165/104 mmHg，尿蛋白排泄量为1.31至1.37 g/24小时，肌酐清除率范围为98 - 133 ml/min/1.73 m²。肾活检显示仅符合糖尿病肾小球硬化的改变。11个月至3年半的随访评估显示，由于使用抗高血压药物，血压降至125/78 - 140/85 mmHg。肌酐清除率增加了12 - 20%，尿蛋白排泄量保持不变。我们得出结论，这些患者可能代表了胰岛素依赖型糖尿病患者中的一个不寻常亚组，他们在肾功能正常的情况下早期出现了临床和病理上的糖尿病肾病。
