ネフローゼ症候群を合併した糖尿病性腎症の臨床経過と予後

Abstract

The aim of this study was to assess the clinical course and prognosis of diabetic nephropathy as confirmed by renal biopsy associated with nephrotic syndrome in patients with non-insulin-dependent diabetes mellitus (NIDDM). We conducted a retro- spective study of 20 patients with NIDDM and nephrotic syndrome who had undergone renal biopsy between 1982 and 1997, and who were observed for at least 6 months until maintenance hemodialysis was started, or until death intervened. The mean duration of follow-up was 30 (range 9-72) months. At the initial renal biopsy, nearly all the patients exhibited advanced, diffuse glomerular lesions with various stages of nodular and vascular lesions. Eight patients required maintenance hemodialysis between 11 and 57 months (mean 36 months) after the renal biopsy; 3 patients died before hemodialysis was initiated; 3 patients were admitted for treatment of congestive heart failure ; 2 patients were lost to follow-up, and 4 patients were alive with stable renal function. The prognosis of NIDDM and nephrotic syndrome is poor, as 11 (55%) of our 20 patients required maintenance hemodialysis or died within a mean period of 3 years after the initial renal biopsy.