2型糖尿病合并非糖尿病性肾损害的临床病理分析

Clinical and Pathological Analysis of Non-diabetic Renal Diseases in Type 2 Diabetes

目的 分析 2型糖尿病 (2 DM )患者合并非糖尿病性肾损害 (NDRD)的临床病理特点 ,提出对 2 DM合并肾损害患者进行肾活检的推荐指征。方法 2 3例 2 DM接受肾穿刺患者 ,回顾性分析其年龄、性别、糖尿病史、肾脏病史、糖尿病并发症情况、尿检、尿蛋白、血糖、血肌酐等临床资料和病理活检的光镜、免疫光镜、电镜等病理资料。结果 2 DM可合并多种原发性或继发性NDRD ,包括IgA肾病、非IgA系膜增生性肾小球肾炎、膜性肾病、微小病变、局灶节段性硬化、高血压肾小动脉硬化、淀粉样变、系统性血管炎等。临床可表现为肾功能不全、肾病综合征、血尿、蛋白尿等。血尿、无肾功能不全的肾病综合征、糖尿病史短高度提示NDRD的存在。糖皮质激素治疗总体上较安全。结论 (1) 2 DM合并肾脏病变可以是NDRD ;(2 )NDRD的疾病谱多种多样 ,以IgA肾病最多见 ;(3)当出现血尿、无肾功能不全的肾病综合征、糖尿病史短等可疑因素时 ,应积极进行肾穿刺检查 ;(4 )对于NDRD 。

Purpose: To analyze clinical and renal pathological information and explore clues to non-diabetic renal diseases (NDRD) in type 2 diabetic (2-DM) patients with renal impairment. Methods: Clinical and renal pathological data of 23 2-DM patients with renal damage were retrospectively studied. Included indicators are age, sex, duration of diabetes and renal disease as well as other complications, laboratory tests on urine analysis, urine protein, blood glucose, serum creatinine and so on. Results: Totally 16 out of the 23 2-DM patients were presented with several types of primary and secondary non-diabetic renal diseases, including IgA nephropathy (7 cases), mesangial proliferative glomerulonephritis (2), membranous nephropathy (2), minimal change (1), focal segmental glomerulosclerosis (1), hypertensive renal arteriolo sclerosis (1), amyloid nephropathy (1) and systemic vasculitis (1). Indicators of NDRD included hematuria, nephrotic syndrome without renal insufficiency and short diabetic history. Therapy with glucosteroid was overall relatively safe. Conclusions: NDRD in 2-DM patients are common and variable in type, in which IgA nephropathy may be the commonest. Hematuria, nephrotic syndrome without renal insufficiency and short diabetic history are possible predicators of NDRD and strongly recommended to renal biopsy. Glucosteroid therapy is overall safe in NDRD patients.