Osterby R, Asplund J, Bangstad H J, Nyberg G, Rudberg S, Viberti G, Walker J D
Institute of Experimental Clinical Research, Aarhus Kommunehospital, Denmark.
Virchows Arch. 1997 Nov;431(5):351-7. doi: 10.1007/s004280050110.
The vascular pole area (VPA) and glomerular volume were measured in renal biopsies from 9 insulin-dependent diabetes mellitus (IDDM) patients with normal albumin excretion rate (IDDM group 1), 38 IDDM patients with albumin excretion rate > 15 micrograms/min (IDDM group 2) and 10 living kidney donors (ND). The volume of individual glomeruli was estimated as the sum of profile areas factored by the measured distance between levels, t approximately 10 microns, and VPA as the sum of chords multiplied by t. Mean glomerular volume was increased in IDDM patients but reached statistical significance only in IDDM group 2 (P = 0.002 vs ND). VPA was significantly different among the groups, mean (CV%) was 2036 (29) microns2 in ND, 3555 (34) micron2 in IDDM group 1, and 3528 (48) microns2 in IDDM group 2, p = 0.004 and 0.001, IDDM versus ND. VPA calculated as a percentage of the surface area of the corresponding glomerulus was 2.4 (23)% in ND, 3.4 (27)% in IDDM group 1, and 3.3 (42)% in IDDM group 2; P = 0.007 and 0.01, IDDM versus ND. The intra-biopsy coefficient of variation was high (20-35%) and of the same order in all groups for all three measurements. Glomerular volume and absolute as well as relative size of VPA showed a positive correlation with estimates of mesangial expansion in IDDM group 2 and the VPA showed a negative correlation with GFR. Thus, part of the enlargement may represent a compensatory phenomenon triggered by the development of structural and functional abnormalities in the diabetic kidney.
对9例白蛋白排泄率正常的胰岛素依赖型糖尿病（IDDM）患者（IDDM第1组）、38例白蛋白排泄率>15微克/分钟的IDDM患者（IDDM第2组）以及10例活体肾供者（ND）的肾活检组织测量血管极面积（VPA）和肾小球体积。单个肾小球的体积通过轮廓面积之和乘以测量的层面间距离（约10微米）来估算，VPA通过弦长之和乘以t来计算。IDDM患者的平均肾小球体积增加，但仅在IDDM第2组达到统计学意义（与ND相比，P = 0.002）。各组间VPA有显著差异，ND组的均值（CV%）为2036（29）平方微米，IDDM第1组为3555（34）平方微米，IDDM第2组为3528（48）平方微米，IDDM与ND相比，P = 0.004和0.001。以相应肾小球表面积的百分比计算的VPA，ND组为2.4（23）%，IDDM第1组为3.4（27）%，IDDM第2组为3.3（42）%；IDDM与ND相比，P = 0.007和0.01。活检组织内变异系数较高（20 - 35%），所有三组的所有三项测量的变异系数处于同一水平。IDDM第2组中，肾小球体积以及VPA的绝对和相对大小与系膜扩张的估计值呈正相关，且VPA与肾小球滤过率呈负相关。因此，部分增大可能代表糖尿病肾病结构和功能异常发展引发的一种代偿现象。
