摘要
目的 分析 2型糖尿病 (T2DM)患者合并非糖尿病肾损害 (NDRD)的临床与病理特点。 方法 回顾性分析 4 2例T2DM患者临床与病理资料 ,比较NDRD患者与糖尿病肾病 (DN)患者发病年龄、病程、视网膜改变、急性肾功能衰竭 (ARF)、尿检等临床表现的异同。 结果 (1)该组肾活检诊断NDRD 2 8例 ,占 6 6 7% ,以轻中度系膜增生性肾炎最常见 (7例 ,2 5 0 % ) ,其次为局灶节段性肾小球硬化 (4例 ,14 3% )和膜性肾病 (3例 ,10 7% ) ;3例患者为DN基础上合并肾小管间质性损害(10 7% )。 (2 )两组患者发病年龄、病程、蛋白尿差异无显著意义 ,但NDRD患者镜下血尿明显 (17/2 8vs 3/14 ,P <0 0 5 ) ,3例患者表现为肉眼血尿 ,4例患者出现急性肾功能衰竭 ,与DN组比较差异有显著意义 (P <0 0 5 )。 (3)肾外表现中 ,NDRD组视网膜病变发生率明显低于DN组 (3/14vs 7/10 ,P <0 0 5 ) ,但高血压发生率、心血管病变两组间差异无显著意义。 (4)该组 4例ARF患者和 8例以大量蛋白尿为主要表现的NDRD患者治疗后获得完全缓解。 结论 糖尿病常伴有NDRD。对于病程短、血尿明显、伴有ARF或不伴有糖尿病视网膜病变者 ,应重视NDRD诊断。
Objective To investigate the pathological and clinical characteristics of non diabetic renal disease(NDRD) in patients with type 2 diabetes mellitus Methods Clinical and renal histological characteristics of 42 patients with type 2 diabetes mellitus were analyzed retrospectively The age of onset, course of disease, retinal changes, acute renal failure (ARF) and urinalysis were analyzed and compared between NDRD and diabetic nephropathy(DN) Results (1)The renal biopsy diagnosis was NDRD in 28 cases of 42 (66 7%), including mesangioproliferative glomerulonephritis (7 patients , 25%), focal segmental glomerulosclerosis (4 patients, 14%) and membranous glomerulonephritis(3 patients, 11%) DN coexisted with glomerulonephritis in 3 patients(10 7%) (2)There were no significant differences in age of onset, duration of disease and the incidence of heavy proteinuria (≥3 5 g/d) between NDRD and DN groups However, microscopic hematuria was more common in NDRD group than in DN group(17/28 vs 3/14, P< 0 05) Three patients had gross hematuria and 4 presented with acute renal failure (3)The incidence of diabetic retinopathy in NDRD group was significantly lower than that in DN group(3/14 vs 7/10), but there was no significant difference in the incidence of hypertension and cardiovascular diseases between the two groups (4)Four patients with ARF and 8 patients with heavy proteinuria acquired remission after treatment Conclusions NDRD is common in patients with type 2 diabetes mellitus The diagnosis of NDRD should be suspected in patients with short course of diabetes, significant hematuria, ARF or in patients without retinopathy
