顕性蛋白尿を呈した糖尿病性腎症の組織病変と透析導入に至る予後

Abstract

The quantity of proteinuria is believed to play an important role in determining the prognosis in various kidney diseases. We investigated the relationship between urinary protein excretion and renal histological severity in patients with overt diabetic nephropathy. A total of 60 patients (male 38, female 22, mean age 58 years old) with type 2 diabetes and overt proteinuria greater than 0.5 g/day and no other renal disease on renal biopsy were divided evenly into the following 3 groups: group L with proteinuria of 0.5～1.5 g/day; group M with proteinuria of 1.6～4.0 g/day; and group H with proteinuria of 4.1～26.4 g/day. Renal histological severity was evaluated numerically and patients were classified into the following groups: glomerular diffuse lesions (D) and nodular lesions (N) were divided into 5 stages; vascular lesions (V) and tubulointerstitial lesions (T) were divided into 4 stages; total histological injury score was calculated using the total score of the above 4 lesions. We investigated the clinical profiles of the 9 patients who could be observed from the time of renal biopsy to induction of hemodialysis. The grades of D and T lesions were significantly higher in group H than in group L. The grades of N lesions were significantly higher in groups M and H than in group L. There was no difference in the severity of V lesions between groups L, M, and H. Total histological injury score was significantly higher in groups M and H than in group L. The interval from renal biopsy to induction of hemodialysis was 38±19 months; serum creatinine concentration was 7.6±1.6 mg/dl at the time of induction of hemodialysis. There was a significant correlation between urinary protein excretion at the time of renal biopsy and declining rate of GFR (r=0.606, p＜0.05). In conclusion, the quantity of proteinuria was related to renal histological severity and prognosis of diabetic nephropathy.