Costa Gil J E, Touceda L A, Pianzola H, Olivares J L, Shwarz E, Cendagorta J, Bruseghini S
Hospital Interzonal General de Agudos, General San Martin, La Plata.
Medicina (B Aires). 1994;54(4):289-300.
The histopathological characteristics of the kidney using light microscopy and immunofluorescence studies in samples obtained by renal percutaneous biopsy in 19 women and 7 men with non-insulin dependent diabetes mellitus (NIDDM) (mean of age: 55.07 +/- 9.04 yr and mean of "known" diabetes duration: 7.50 +/- 6.87 yr) were studied. The relationship with age, blood pressure, diabetic retinopathy and other complementary diagnostic methods such as serum creatinine (Cr), creatinine clearance (CrC), renal plasma flow (RPF), proteinuria and filtration fraction (FF) were also determined. Light microscopy studies detected 92.3% of patients with renal lesions of different degrees of severity. The presence and severity of glomerulopathy and arteriolopathy were related to diabetes duration (r: 0.764) and they were related to each other (rs: 0.773). In 2 patients, lesions were not observed and in 11 out of 14 patients with less than 5 yr of diabetes duration, mild lesions were detected. However, the histological changes became worse after that period. The glomerulopathy was also statistically correlated with Cr, CrC, RPF, proteinuria and FF. By immunofluorescence, fibrinogen, IgA and C3 were the most frequent and intense precipitates observed. They increased with diabetes duration and were located predominantly in the wall and the periphery of the glomerules and in renal tubules, suggesting that they originated by trapping. There were no precipitates in the mesenchyma, they were scarce in the interstice, Bowman's capsule and arterioles. Statistical correlation between diabetic histopathological renal changes and retinopathy was found. These results confirm that lesions in the kidney and retina in non-insulin dependent diabetic patients generally appear and evolve in a similar manner. Hypertension was diagnosed in 80.76% of patients, without statistical correlation between blood pressure and renal lesions. This suggests that at the onset, in non-insulin dependent diabetic patients hypertension and nephro-pathy are caused by different and independent pathogenic mechanisms. However, at an end stage, it seems that both situations can influence each other in a way that their evolution becomes more severe. Nephropathy in non-insulin dependent diabetes mellitus displayed scarce clinical signs and poor laboratory evidence except when the renal lesions become too severe. The lack of correlation between renal lesions and patients' age and blood pressure suggests the participation of diabetes at the onset of kidney structural impairment.
对19名女性和7名男性非胰岛素依赖型糖尿病（NIDDM）患者（平均年龄：55.07±9.04岁，平均“已知”糖尿病病程：7.50±6.87年）经皮肾穿刺活检获取的样本进行光镜和免疫荧光研究，以观察肾脏的组织病理学特征。还确定了其与年龄、血压、糖尿病视网膜病变以及其他辅助诊断方法如血清肌酐（Cr）、肌酐清除率（CrC）、肾血浆流量（RPF）、蛋白尿和滤过分数（FF）之间的关系。光镜研究发现92.3%的患者存在不同程度的肾脏病变。肾小球病和小动脉病的存在及严重程度与糖尿病病程相关（r：0.764），且二者相互关联（rs：0.773）。2例患者未观察到病变，在糖尿病病程小于5年的14例患者中，11例检测到轻度病变。然而，在此之后组织学变化会加重。肾小球病在统计学上也与Cr、CrC、RPF、蛋白尿和FF相关。通过免疫荧光检测，纤维蛋白原、IgA和C3是观察到的最常见且沉淀强烈的物质。它们随糖尿病病程增加，主要位于肾小球壁和周边以及肾小管，提示其通过捕获形成。间质中无沉淀，在间隙、鲍曼囊和小动脉中沉淀较少。发现糖尿病肾脏组织病理学变化与视网膜病变之间存在统计学相关性。这些结果证实，非胰岛素依赖型糖尿病患者的肾脏和视网膜病变通常以相似的方式出现和发展。80.76%的患者被诊断为高血压，血压与肾脏病变之间无统计学相关性。这表明在疾病初期，非胰岛素依赖型糖尿病患者的高血压和肾病由不同且独立的致病机制引起。然而，在终末期，似乎两种情况会相互影响，使其病情发展更为严重。非胰岛素依赖型糖尿病肾病除肾脏病变过于严重外，临床症状稀少且实验室证据不足。肾脏病变与患者年龄和血压之间缺乏相关性，提示糖尿病在肾脏结构损害起始阶段起作用。
