高度の問質病変を示した糖尿病性腎症の4例

Abstract

Four male patients with diabetic nephropathy who had no or only mild glomerular lesions but did have severe interstitial lesions are reported. The mean duration of diabetes was 4.3 years. All patients had coronary artery disease and smoked, two had hypertension, and none had diabetic retinopathy. Microalbuminuria was detected in 2 patients, and increases in urinary excretion of β2-microglobulin and/or NAG were obser- ved in 3 patients. Renal biopsy specimens in all 4 patients revealed severe interstitial fibrosis with or without infiltration by mononuclear cells, and arteriolar hyalinosis. Drug -induced nephropathy, pyelonephritis, gouty kidney, hypokalemia and hypercalcemia were excluded. These observations suggested the hypothesis that diabetes mellitus directly affects the development of interstitial lesions associated with ischemic renal injury induced by arterio- and/or arteriolosclerosis.