インスリン非依存型糖尿病における腎病変の定量形態学的検討 : (第1報)早期腎病変

Abstract

Increased urinary albumin excretion (UAE) is a marker of incipient diabetic nephropathy. I examined renal biopsy specimens in patients with normoalbuminuria and microalbuminuria to disclose early morphological changes in non-insulin-dependent diabetes mellitus (NIDDM). Diabetic subjects were 30 patients with normoalbuminuria (group N ; UAE<20μg/min) and 22 patients with microalbuminuria (group M ; 20≦UAE<200μg/min). Ten non-diabetic patients (group C) and their kidney tissue resectedsurgically were compared for reference. Glomerular area (GA), mesangial rate (MR) and percentage of global glomerulosc1erosis (GS) were quantified by light microscopy with a color image processor histomorphometrically. GA was not significantly different in the three groups. In addition, Ccr was not different in the three groups. MR was significantly increased in group N compared with group C (p<0.05), and in group M compared with group C (p<0.0001). MR was also significantly increased in group M compared with group N (p<0.01). GS was not significantly different in the three groups. These results suggest that neither glomerular hypertrophy nor hyperfi1tration exist in NIDDM at the ear1y stage, and mesangial expansion proceeds before the existence of microalbuminuria.