Lauszus F F, Klebe J G, Rasmussen O W, Klebe T M, Dørup J, Christensen T
Gynaecological Department Y, Aarhus Kommunehospital, Denmark.
Acta Diabetol. 1995 Dec;32(4):225-9. doi: 10.1007/BF00576254.
Kidney volume was measured during pregnancy in insulin-dependent diabetic women by an ultrasound technique and prognostic value of these measurements evaluated. A prospective study was performed on 87 pregnant women with insulin-dependent diabetes attending the maternity clinic of Aarhus Kommunehospital. Patients with proliferative retinopathy alone, hydronephrosis, or nephrotic syndrome were excluded. The patients were grouped according to onset and duration of diabetes and to vascular lesions; group I (n = 35, White class B+C), group II (n = 11, White class D0), group III (n = 26, White class D+), and group IV (n = 15, White class F+F/R). The patients visited the hospital every 2 weeks during pregnancy for general obstetric and glycaemic control and blood sampling. The volume of both kidneys was measured by a computerized nephrosonograph during the three terms of pregnancy, the puerperium and 4 months postpartum. The kidney volume increased significantly in all four groups from first to third trimester. In the third trimester the kidney volumes were 375 +/- 68 ml (I), 341 +/- 50 ml (II), 362 +/- 63 ml (III), and 343 +/- 54 ml (IV). The kidney volume in the third trimester was positively correlated with creatinine clearance (r = 0.33, P < 0.01) and inversely correlated with creatinine in serum (r = -0.27, P = < 0.02). Total kidney volume decrease (in percent) defined as the difference of maximal volume and value at 4 months postpartum was inversely correlated to albuminuria in the third trimester (r = -0.25, P < 0.05) and vascular lesions of the patients: (mean +/- SEM) 37 +/- 4% (I), 25 +/- 7% (II), 19 +/- 5% (III), and 11 +/- 7% (IV), P < 0.01. In the puerperium, kidney volume decreased significantly from third trimester in groups I, II, and III, whereas we observed no change in group IV. Six of 15 women in groups II and III with kidney volume < 300 ml and normoalbuminuria in the first trimester developed persistent microalbuminuria after pregnancy (P < 0.02). The renal volume in insulin-dependent diabetic women increases significantly during pregnancy and is inversely related to the vascular lesions of the patients. The decrease in renal volume after pregnancy is related to the albuminuria at the end of pregnancy. Women with longstanding diabetes, White class D (= groups II+III), and kidney volume < 300 ml in the first trimester have a high risk of developing permanent microalbuminuria after pregnancy.
采用超声技术测量胰岛素依赖型糖尿病女性孕期的肾脏体积，并评估这些测量值的预后价值。对87名到奥胡斯市立医院产科就诊的胰岛素依赖型糖尿病孕妇进行了一项前瞻性研究。排除仅患有增殖性视网膜病变、肾积水或肾病综合征的患者。根据糖尿病的发病时间、病程以及血管病变情况对患者进行分组：第一组（n = 35，怀特B + C级），第二组（n = 11，怀特D0级），第三组（n = 26，怀特D +级），第四组（n = 15，怀特F + F/R级）。患者在孕期每2周到医院进行一次常规产科检查、血糖控制及血液采样。在孕期的三个阶段、产褥期及产后4个月，使用计算机化肾超声仪测量双侧肾脏的体积。所有四组患者的肾脏体积从孕早期到孕晚期均显著增加。孕晚期时，肾脏体积分别为：第一组375±68 ml，第二组341±50 ml，第三组362±63 ml，第四组343±54 ml。孕晚期肾脏体积与肌酐清除率呈正相关（r = 0.33，P < 0.01），与血清肌酐呈负相关（r = -0.27，P = < 0.02）。以产后4个月时的体积与最大体积之差计算的肾脏总体积减少百分比与孕晚期蛋白尿呈负相关（r = -0.25，P < 0.05），也与患者的血管病变相关：（均值±标准误）第一组37±4%，第二组25±7%，第三组19±5%，第四组11±7%，P < 0.01。在产褥期，第一组、第二组和第三组的肾脏体积从孕晚期开始显著下降，而第四组未观察到变化。第二组和第三组中，孕早期肾脏体积< 300 ml且无蛋白尿的15名女性中有6名在产后出现持续性微量蛋白尿（P < 0.02）。胰岛素依赖型糖尿病女性的肾脏体积在孕期显著增加，且与患者的血管病变呈负相关。产后肾脏体积的减少与孕末期的蛋白尿有关。糖尿病病程长、怀特D级（即第二组和第三组）且孕早期肾脏体积< 300 ml的女性产后发生永久性微量蛋白尿的风险较高。
