Hariharan S, Smith R D, Viero R, First M R
Department of Internal Medicine, University of Cincinnati Medical Center, Ohio 53267, USA.
Transplantation. 1996 Sep 15;62(5):632-5. doi: 10.1097/00007890-199609150-00016.
The histologic diagnosis of diabetic glomerulosclerosis was made in 14 renal transplant recipients. All 14 had insulin-dependent diabetes mellitus, which was the original cause of end-stage renal disease in 12; one patient had membranoproliferative glomerulonephritis and another patient had membranous nephropathy as the cause of end-stage renal disease. Insulin-dependent diabetes mellitus was diagnosed at an average age of 18.5 years (range, 8-41 years), and the mean duration of diabetes prior to transplantation was 15 years (range, 2-25 years). All patients were recipients of first kidney transplants (six living related donors and eight cadavers). The histologic diagnosis of diabetic glomerulosclerosis was made on average, 97 months after transplantation (range 41-154 months). All 14 patients had proteinuria (mean 5.3 g/24 hr; range 1.1-12 g/24 hr) and renal dysfunction (mean serum creatinine level, 2.8 mg/dl). Patient and graft survival rates at 1 year, 5 years, and 10 years after transplantation were 100%, 92%, and 59%, and 100%, 92%, and 34%, respectively. Graft failure was due to diabetic nephropathy in seven patients, diabetic nephropathy and membranous nephropathy in one patient, and death due to a cerebrovascular accident in one patient. A total of five patients are alive with a functioning kidney. Of the eight patients who returned to dialysis, four are alive, three remain on dialysis, and 1 had a combined kidney and pancreas transplant. Histologic findings were as follows: 9/14 had moderate or severe diffuse glomerular basement membrane thickening and 2/14 had nodular glomerulosclerosis. Arteriolar lesions were prominent in all cases and was graded moderate or severe in 11 cases. The development of allograft diabetic nephropathy is associated with a high rate of allograft failure.
14例肾移植受者被诊断为糖尿病性肾小球硬化。这14例患者均患有胰岛素依赖型糖尿病，其中12例患者的终末期肾病最初由胰岛素依赖型糖尿病引起；1例患者的终末期肾病由膜增生性肾小球肾炎引起，另1例患者由膜性肾病引起。胰岛素依赖型糖尿病的诊断平均年龄为18.5岁（范围8 - 41岁），移植前糖尿病的平均病程为15年（范围2 - 25年）。所有患者均接受首次肾移植（6例为活体亲属供肾，8例为尸体供肾）。糖尿病性肾小球硬化的组织学诊断平均在移植后97个月（范围41 - 154个月）做出。所有14例患者均有蛋白尿（平均5.3g/24小时；范围1.1 - 12g/24小时）和肾功能不全（平均血清肌酐水平为2.8mg/dl）。移植后1年、5年和10年的患者生存率分别为100%、92%和59%，移植肾生存率分别为100%、92%和34%。移植肾失功的原因，7例为糖尿病肾病，1例为糖尿病肾病合并膜性肾病，1例因脑血管意外死亡。共有5例患者存活且移植肾功能良好。在8例恢复透析的患者中，4例存活，3例仍在透析，1例接受了肾胰联合移植。组织学表现如下：14例中有9例出现中度或重度弥漫性肾小球基底膜增厚，14例中有2例出现结节性肾小球硬化。所有病例中，小动脉病变均很突出，11例为中度或重度。同种异体移植糖尿病肾病的发生与移植肾高失功率相关。
