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2報)顕性腎症

Abstract

The diagnosis of overt diabetic nephropathy is performed by persistent proteinuria (>0.5g/day). I examined renal biopsy specimens in patients with overt diabetic nephropathy, inc1uding patients with nephrotic syndrome, to disclose advanced morphological changes in non-insulin-dependent diabetes mellitus (NIDDM). Diabetic subjects were 9 patients with persistent proteinuria without nephrotic syndrome (group O) and 12 patients with nephrotic syndrome (group NS). Twenty-two diabetic patients with microalbuminuria (20≦urinary albumin excretion<200μg/min) were enrolled for reference (group M). Glomerular area (GA), mesangial rate (MR) and percentage of global glomerulosc1erosis (GS) were quantified by light microscopy with a color image processor histomorphometrically. GA in group NS was significantIy larger than that in group M (p<0.05). MR was significantly increased in group NS compared with both group O (p<0.05) and group M (p<0.0001). GS was significantly increased in both group O and group NS compared with group M (p<0.05). GS was not orrelated with GA in overt diabetic nephropathy. This study shows the existence of glomerular hypertrophy of advanced diabetic nephropathy with nephrotic syndrome in NIDDM. But it was not proved that this hypertrophy took place as a compensatory phenomenon to supplement the decrease of Ccr caused by the existence of global glomerulosc1erosis.