2型糖尿病患者合并非糖尿病肾病的临床诊断

Differentiation on Concomitant of non-diabetic renal disease from diabetic nephropathy in type 2 diabetes Mellitus

目的 分析 2型糖尿病 (DM )患者合并非糖尿病肾病 (NDRD)与糖尿病肾病 (DN )在临床表现、病程、病理改变的异同 ,以指导临床诊断与治疗。方法 2型DM患者 3 4例分为两组 ,合并NDRD组 2 2例 ,单纯DN组 12例。对两组发病年龄、糖尿病病程、蛋白尿、血尿、肾功能、高血压、视网膜病变、肾脏病理等资料进行对比分析。结果 DM病程在NDRD组短于DN组 ;两组蛋白尿程度相似 ;血尿伴蛋白尿的发生率在NDRD组略多于DN组 ;肾功能损害在NDRD组更显著 ;伴高血压者DN组多于NDRD。视网膜病变并发率在DN组为 10 0 % ,且为Ⅱ～Ⅳ期病变 ,NDRD组仅有 2例伴发Ⅱ期病变。 3 0例患者行肾穿刺活检 ,12例呈不同阶段的DN ,18例伴发不同类型的肾小球肾炎。结论 糖尿病合并非糖尿病肾病者平均糖尿病病程多 <5年 ;突然出现大量蛋白尿、水肿、而肾功能正常者 ;单纯肾性血尿 ,或血尿加蛋白尿者 ;肾功能迅速减退者 ;不伴视网膜病变者 ;肾小管功能受损显著者 。

Objective To analyse the differences between the clinical symptoms, clinical course and renal pathologic features in type 2 diabetes mellitus(DM) patients with non-diabetic renal disease(NDRD) or diabetic nephropathy(DN).Methods 34 patients with type 2 diabetes and renal involvement were studied and divided into 2 groups.There were 22 patients in a group of NDRD and 12 in a group of DN.Comparison was carried out between the two groups on age incidence,clinical course,proteinuria,hematuria,renal function,blood pressure,retinopathy and pathologic appearance of renal biopsy.Results The average clinical course of NDRD was shorter than that of DN.The quantity of proteinuria was similar in both groups.There was one patient showing hematuria alone and 11 patients showing hematuria and proteinuria in the group NDRD;the incidence of hematuria was a little more than that in DN.The renal function was more seriously impaired in NDRD than in DN.75% of the patients was hypertensive in group DN,being more than that in group NDRD(50%).All the patients in group DN had stage Ⅱ～Ⅳ diabetic retinopathy,but only 2 patients had stage Ⅱ diabetic retinopathy in group NDRD.Renal biopsy was done in 30 patients.The 12 patients in group DN were shown to be in different stages of DN.18 in group NDRD were diagnosed with different kinds of glomerulonephritis.Conclusion When diabetic patients have a clincal course of less than five years;rapid emergence of massive proteinuria or severe edema,relatively normal renal function;glomerular hematuria alone or hematuria plus proteinuria;rapid appearance of renal insufficiency;absence of diabetic retinopathy and serious impairment of renal tubular function,the possibility of diabetes mellitus with concomitant non-diabetic renal disease should be considered. [