Paulsen E P, Burke B A, Vernier R L, Mallare M J, Innes D J, Sturgill B C
Department of Pediatrics, University of Virginia Health Sciences Center, Charlottesville.
Kidney Int. 1994 Apr;45(4):1132-9. doi: 10.1038/ki.1994.150.
Abnormal microalbuminuria in insulin-dependent diabetic subjects (IDDS) is significantly associated with pre-clinical nephropathy. In youth-onset IDDS declining plasma renin activity is significantly associated with improved albumin excretion, while persistently elevated renin activity is associated with continued abnormal microalbuminuria. To determine if these changes are reflected in changes in cell count in the juxtaglomerular body and if biopsy findings correlate with abnormal microalbuminuria, renal tissue of 20 IDDS (Study IDDS) ages 16 to 31 years, evaluated concurrently for plasma renin activity and microalbuminuria, were examined by light microscopy. Biopsy or autopsy specimens from 21 normal subjects and 32 IDDS (Non-Study IDDS), ages 2 to 25, were also examined. Specimens from the majority of prepubertal and all pubertal and postpubertal Non-Study IDDS and all Study IDDS independently of status of microalbuminuria had morphologic abnormalities. Normal or mesangially expanded glomeruli were found in association with expanded juxta-glomerular bodies and increased cell number, or with sclerotic bodies and decreased cell number. Sclerosis of juxtaglomerular bodies occurred independently of glomerular sclerosis. The highest percentage of glomeruli with expanded juxtaglomerular bodies and high cell count was present in specimens of Study IDDS with the most abnormal levels of microalbuminuria. T lymphocytes, noted within juxtaglomerular bodies, were present in specimens of 62% of the 52 Study and Non-Study IDDS. Abnormalities of the juxtaglomerular body are distinctive features of renal pathology in IDDS. T lymphocytes in the endocrine juxtaglomerular body suggest the presence of an autoimmune process. Confirmatory studies are necessary.
胰岛素依赖型糖尿病患者（IDDS）的微量白蛋白尿异常与临床前期肾病显著相关。在青少年起病的IDDS中，血浆肾素活性下降与白蛋白排泄改善显著相关，而肾素活性持续升高则与持续的微量白蛋白尿异常相关。为了确定这些变化是否反映在球旁体的细胞计数变化中，以及活检结果是否与微量白蛋白尿异常相关，对20例年龄在16至31岁之间的IDDS（研究IDDS）的肾组织进行了光学显微镜检查，这些患者同时接受了血浆肾素活性和微量白蛋白尿评估。还检查了21例正常受试者以及32例年龄在2至25岁之间的IDDS（非研究IDDS）的活检或尸检标本。大多数青春期前以及所有青春期和青春期后的非研究IDDS和所有研究IDDS的标本，无论微量白蛋白尿状况如何，均有形态学异常。发现正常或系膜扩张的肾小球与球旁体扩张和细胞数量增加相关，或与硬化体和细胞数量减少相关。球旁体硬化独立于肾小球硬化发生。在微量白蛋白尿水平最异常的研究IDDS标本中，球旁体扩张且细胞计数高的肾小球比例最高。在52例研究和非研究IDDS中，62%的标本的球旁体内发现了T淋巴细胞。球旁体异常是IDDS肾病理学的独特特征。内分泌球旁体内的T淋巴细胞提示存在自身免疫过程。需要进行验证性研究。
