Kanauchi M, Kawano T, Uyama H, Shiiki H, Dohi K
1st Department of Internal Medicine, Nara Medical University, Nara, Japan.
Nephron. 1998 Oct;80(2):171-4. doi: 10.1159/000045162.
The aim of this study was to investigate the relationship between the grade of retinopathy and the severity of glomerular lesions in patients with type 2 diabetes and to describe 5 patients without diabetic retinopathy for whom renal biopsy specimens demonstrated advanced diabetic nephropathy. A total of 221 patients with type 2 diabetes (139 males and 82 females) who consectively underwent renal biopsy between 1982 and 1996 were investigated. The severity of diffuse glomerular lesions was graded using the criteria of Gellman and coworkers, and diabetic retinopathy was classified as absent, nonproliferative, or proliferative. The incidence of advanced nephropathy without retinopathy for all 221 cases was 2.3%. Advanced nephropathy was present in 5 of the 122 (4.1%) patients without retinopathy. These 5 patients were all males and aged 50-70 (mean 61) years. Their clinical characteristics were not uniform, and no special clinical features distinguished the patients who were regarded as having possible advanced nephropathy without retinopathy. In our study, although concordance of retinopathy and nephropathy is relatively common, a little discordance was pronounced in Japanese type 2 diabetic patients. Our findings are consistent with the hypothesis that there are important differences in some aspects of the pathogenesis of retinopathy and nephropathy.
本研究旨在调查2型糖尿病患者视网膜病变分级与肾小球病变严重程度之间的关系，并描述5例无糖尿病视网膜病变但肾活检标本显示存在晚期糖尿病肾病的患者。对1982年至1996年间连续接受肾活检的221例2型糖尿病患者（139例男性和82例女性）进行了调查。根据盖尔曼及其同事的标准对弥漫性肾小球病变的严重程度进行分级，糖尿病视网膜病变分为无、非增殖性或增殖性。在所有221例病例中，无视网膜病变的晚期肾病发生率为2.3%。在122例无视网膜病变的患者中，有5例（4.1%）存在晚期肾病。这5例患者均为男性，年龄在50 - 70岁（平均61岁）之间。他们的临床特征并不一致，没有特殊的临床特征能区分被认为可能患有无视网膜病变的晚期肾病的患者。在我们的研究中，虽然视网膜病变和肾病的一致性相对常见，但在日本2型糖尿病患者中也明显存在一些不一致性。我们的研究结果与以下假设一致，即视网膜病变和肾病的发病机制在某些方面存在重要差异。
