Gault M H, Fernandez D
Memorial University, St. John's, NF, Canada.
Nephron. 1996;72(1):86-92. doi: 10.1159/000188812.
It has been considered unlikely that patients with insulin-dependent diabetes and diabetic nephropathy with nephrotic range proteinuria can substantially reduce proteinuria and continue for many years without further loss of renal function. We present a patient who had the diagnosis of insulin-dependent diabetes made at age 15, had his first of 6 laser treatments for proliferative and hemorrhagic retinopathy at age 27 and was found to have nephrotic range proteinuria and edema with hypertension at age 29, when results of a renal biopsy were typical of diabetic nephropathy. Ten years later, with the last 5.5 years on ACE inhibitors, proteinuria has been < 0.65 g/24 h for 2 years and recently 0.22 g, serum creatinine is unchanged at 90 to 102 mu mol/l, DTPA GFR is 104 ml/min and retinopathy has remained stable without laser therapy for 7 years. Blood pressure on clinic visits has averaged 126/74 for the last 8 years. This duration of stable renal function and the major decrease in proteinuria after being in the neprotic range is very rare in reports, if not unique.
胰岛素依赖型糖尿病合并糖尿病肾病且蛋白尿达到肾病范围的患者，一直被认为不太可能大幅降低蛋白尿水平，并在多年内维持肾功能而无进一步丧失。我们报告一位患者，其在15岁时被诊断为胰岛素依赖型糖尿病，27岁时因增殖性和出血性视网膜病变接受了6次激光治疗中的首次治疗，29岁时发现有肾病范围的蛋白尿、水肿及高血压，当时肾活检结果为典型的糖尿病肾病。十年后，在使用血管紧张素转换酶抑制剂的最后5.5年里，蛋白尿<0.65 g/24 h已持续2年，最近为0.22 g，血清肌酐维持在90至102 μmol/l不变，二乙三胺五乙酸肾小球滤过率为104 ml/min，视网膜病变在未接受激光治疗的情况下已稳定7年。在过去8年的门诊就诊中，血压平均为126/74。这种稳定的肾功能持续时间以及蛋白尿在达到肾病范围后大幅下降的情况，即便不是独一无二的，在报告中也是非常罕见的。
