糖尿病合并原发性肾病综合征临床病理分析

Pathological features of Type 2 diabetic patients with primary nephrotic syndrome

目的:分析2型糖尿病(2-DM)患者合并原发性肾病综合征的临床病理特点,提出对2-DM合并肾病综合征患者进行肾活检的推荐指征。方法:可疑患者接受肾穿刺,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、尿蛋白、血糖、血肌酐等临床资料和肾活检的光镜、免疫光镜、电镜等病理资料。结果:2-DM可合并原发性肾小球疾病,临床可表现为肾病综合征;糖尿病病史短、全身情况良好、无肾功能不全的肾病综合征,高度提示合并原发性肾小球疾病的存在;糖皮质激素治疗较安全。结论:①2-DM合并原发性肾小球疾病并非罕见;②如有出现突然的蛋白尿、无视网膜病变、糖尿病病史短等可疑因素时,应积极进行肾穿刺检查;③合并原发性肾病综合征时,糖尿病并非使用糖皮质激素的禁忌症。

Objective ： To suggest the indications of renal biopsy necessary for Type 2 diabetic patients with primary nephritic syndrome by analyzing the pathological characteristics of the diseases. Methods ： The clinical data were reviewed eonceruing the ages, sexes, history of diabetes and kidney disease, diabetic complications, proteinuria, blood glucose, blood serum creatinine and the pathological manifestation of kidney by optical micro- scope,immunohistochemistry light microscope and electron microscope after renal biopsy in all patients suspected or DM. Results ： Clinically, nephrotic syndrome could be shown in T2DM with primary glomerular disease. The patients of nephritic syndrome with short history of diabetes, good body condition and absence of renal insufficiency might be highly present of primary glomerular disease. Cortieosteroid is safe in treatment of this disease. Conclusion ：①T2DM with primary glomerular disease is not rare in clinic ; ②Renal biopsy should be done considering questionable symptoms with abrupt presence of proteinuria,non - retinopathy and short history of diabetes and ③corticosteroid can be used in T2DM with primary nephrotic syndrome.