糖尿病肾病合并非糖尿病肾脏病变的临床病理分析

Clinical pathological analysis of non-diabetic renal diseases in patients with diabetic nephropathy

目的 回顾性分析糖尿病肾病合并非糖尿病肾脏病变的发生率和临床病理特征。方法 回顾性研究了 1 990～ 2 0 0 0年诊断为糖尿病肾病的 1 1 4例患者。结果 糖尿病肾病患者中有 1 4 .9%的患者合并非糖尿病肾脏病变 ,男性 1 3例 ,女性 4例 ,平均就诊年龄为 (51± 1 0 .2 )岁 ,31～ 65岁。在所有的非糖尿病肾脏病变中 ,IgA肾病的比率最高为 47.1 % ,其他依次为膜性肾病 1 7.6 % ,间质性肾炎 1 1 .7% ,高血压肾损害 5 .9% ,微型多动脉炎5 .9% ,肾淀粉样变性 5 .9% ,紫癜性肾炎 5 .9%。所有患者临床均表现为蛋白尿 ,8例为镜下血尿 ,糖尿病视网膜病变发病率低。患者组织学呈现上述肾脏疾病相应的病理特征。结论 糖尿病肾病患者合并非糖尿病肾脏病变的发生率为 1 4 .9% ,其中发生率最高的是IgA肾病和膜性肾病 ,其次为间质性肾炎、高血压肾损害、微型多动脉炎、肾淀粉样变性、紫癜性肾炎。这部分患者的糖尿病病程相对较短 ,临床和病理表现呈多样化特点 ,缺乏特征性的诊断指标。对于临床表现为蛋白尿和 (或 )血尿的患者 ,不论有无眼底病变 ,肾活检都是一项排除非糖尿病肾脏病变的重要手段。

Objective To investigate the incidence, pathological distribution and clinical characteristics of non diabetic renal disease (NDRD) in patients with diabetic nephropathy (DN). Methods A total of 114 type 2 diabetic patients who had renal biopsies performed during 1990 2000 were studied retrospectively. Renal diseases other than diabetic nephropathy were found in 17 patients, whose clinical and pathological features were well observed. Results In the 114 DN patients,there were 17(14.9%)complicated with NDRD (13 males and 4 females). Their ages on admission ranged from 31 to 65 years old (mean 51±10.19). In NDRD, IgA nephropathy was the most common disease,accounting for 47.1%, followed by membrane nephropathy in 17.6%, tubular interstitial nephritis in 11.7%, renal injuries induced by hypertension in 5.9% , microscopic polyangiitis in 5.9%, renal amyloidosis in 5.9% and Henoch Schnlein purpura in 5.9% . All patients presented proteinuria and 8 had micro hematuria, while retinopathy was rare in patients with NDRD. Histologic evaluation paralleled the characteristics of different disease entities. Conclusions There were 14.7% of DN patients complicated with NDRD. In NDRD ,the most frequent disease entities are IgA nephropathy and membrane nephropathy,followed by tubular interstitial nephritis, renal injuries induced by hypertension, microscopic polyangiitis, renal amyloidosis and Henoch Schnlein purpura. For comparatively short course of disease, inconstant clinical and pathological characteristics, distinctive diagnosis can easily be made. It is necessary that type 2 diabetic patients with proteinuria and/or hematuria, no matter with or without retinopathy, should receive renal biopsiy to make sure whether NDRD coexists.