Bhathena D B
Department of Pathology, Wayne State University, Detroit, MI 48201, USA.
J Am Soc Nephrol. 1996 Dec;7(12):2600-3. doi: 10.1681/ASN.V7122600.
This study examines the relationship of the degree of glomerular hypertrophy in nephronopenia to the development of focal segmental glomerulosclerosis (FGS) in humans. To this end, group mean glomerular diameters in a variety of acquired and congenital nephronopenic states in native kidneys and long-surviving renal allografts with and without FGS were analyzed and compared. The results indicate that all groups of native nephronopenic kidneys without FGS develop significant and equivalent glomerular hypertrophy. By contrast, long-surviving renal allografts without FGS do not undergo glomerular hypertrophy. For groups with FGS, long-surviving renal homografts had a significantly smaller mean glomerular diameter when compared with any other group of native nephronopenic kidneys. There was no significant difference among group mean glomerular diameters of native nephronopenic kidneys with FGS. Pairwise comparisons in each category of nephronopenia indicated that, except in the groups with uninephrectomy, the mean glomerular diameters were significantly larger in those with FGS than without. These observations are interpreted to indicate that nephronopenic individuals with native kidneys, by undergoing glomerular hypertrophy, consume much or all their capacity for glomerular enlargement. This brings them closer to their maximal diameters at which FGS develops. Finally, long-surviving renal allografts without nephronopenic FGS do not undergo glomerular hypertrophy. However, when FGS develops in long-surviving allografts, it does so at glomerular diameters significantly smaller than in native nephronopenic kidneys, reflecting their decreased capacity to undergo glomerular hypertrophy, acquiring maximal diameters at a smaller dimension than native nephronopenic kidneys.
本研究探讨了人类肾单位减少时肾小球肥大程度与局灶节段性肾小球硬化（FGS）发生之间的关系。为此，分析并比较了各种获得性和先天性肾单位减少状态下，有或无FGS的天然肾脏以及长期存活的肾移植受者的组平均肾小球直径。结果表明，所有无FGS的天然肾单位减少的肾脏组均出现显著且相当程度的肾小球肥大。相比之下，无FGS的长期存活肾移植受者未发生肾小球肥大。对于有FGS的组，长期存活的同种异体肾移植受者的平均肾小球直径与任何其他天然肾单位减少的肾脏组相比显著更小。有FGS的天然肾单位减少的肾脏组之间的组平均肾小球直径无显著差异。在每种肾单位减少类型中的两两比较表明，除了单侧肾切除组外，有FGS者的平均肾小球直径显著大于无FGS者。这些观察结果被解释为表明，有天然肾脏的肾单位减少个体通过经历肾小球肥大，消耗了其大部分或全部的肾小球增大能力。这使它们更接近FGS发生时的最大直径。最后，无肾单位减少性FGS的长期存活肾移植受者未发生肾小球肥大。然而，当长期存活的同种异体肾移植受者发生FGS时，其发生时的肾小球直径显著小于天然肾单位减少的肾脏，这反映出它们的肾小球肥大能力下降，在比天然肾单位减少的肾脏更小的尺寸时达到最大直径。
