Ⅱ型糖尿病患者非糖尿病肾病肾脏病变的临床病理分析  

Non-diabetic Renal Diseases in Patients with Non-insulin Dependent Diabetes

作　　者：唐政[1] 胡章学[1] 蒋春明[1] 胡伟新[1] 陈惠萍[1] 刘志红[1] 黎磊石[1] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院肾脏科,南京210002

出　　处：《南京大学学报（自然科学版）》2001年第2期252-255,共4页Journal of Nanjing University（Natural Science）

摘　　要：为了比较II型糖尿病患者糖尿病肾病 (DN)与非糖尿病肾病肾脏病变 (NDRD)的临床特点 ,对 30例行肾活检明确诊断为NDRD患者的临床表现、心肾功能及眼底病变与 6 8例DN患者进行比较 .结果 :30例NDRD患者中IgA肾病最常见 10例 (33.3% ) ,其次为膜性肾病(MN) (8例 ) ,高血压性肾损害 (5例 ) ,间质性肾炎 (4例 ) ,微小病变 ,链球菌感染后肾炎及局灶节段性肾小球硬化 (FSGS) (各 1例 ) .临床上与DN患者比较 ,肾炎综合征及血尿多见 ,糖尿病及糖尿病至肾脏病变出现的时间均较短 ;肾外症状则视网膜病变明显增多 .由此可见约有 1/3II型糖尿病合并肾脏病变患者为NDRD ;II糖尿病患者在出现尿蛋白时是否合并有糖尿病视网膜病变是鉴别NDRD的重要指标 ;有时单靠临床指标很难区分两者 ,并难于明了NDRD的具体类型 ,在这种情况下肾活检是鉴别诊断的重要手段 .In order to investigate the incidences, pathological distributions and clinic characteristics of non diabetic renal diseases (NDRD) in patients with non insulin dependent diabetes (NIDDM), during the period of July 1987 June 1998, the medical record and kidney biopsy results were reviewed in ninety eight NIDDM patients with renal impairment, 62 males and 36 females (1.72:1). Their age at the onset of renal diseases ranged from 33 to 68 years old (mean 54.9±8.6). Thirty were diagnosed as NDRD and sixty eight as diabetic nephropathy (DN). In NDRD, IgA nephropathy was the most common in 33.3%, followed by membrane nephropathy in 26.7%, renal injuries induced by hypertension in 16.7%, acute tubular interstitial nephritis in 13.3%, minimal change in 3.3%, endocapillary proliferative glomerulonephritis in 3.3% and focal segmental glomerulosclerosis in 3.3%. Nephritic syndrome and gross hematuria were more common, and retinopathy was rare in patients with NDRD compared with that in DN patients alone. In conclusion, at least one third of NIDDM patients with renal impairment do not have DN. Patients with an acute change in renal function will be considered likely to have other renal diseases. Patients with gross or apparent hematuria and without retinopathy also indicate to have NDRD. It is necessary that NIDDM patients with proteinuria or hematuria should receive renal biopsies if utilization of these predicted parameters can not makea diagnosis.

关 键 词：Ⅱ型糖尿病 糖尿病肾病 临床病理 肾脏病变 视网膜病变 蛋白尿 

分 类 号：R691.202[医药卫生—泌尿科学] R587.1[医药卫生—外科学]