2型糖尿病患者合并非糖尿病性肾损害的临床病理分析

目的：了解2型糖尿病合并非糖尿病性肾损害的临床病理特点。方法：总结分析29例2型糖尿病合并非糖尿病肾损害的临床资料、病理改变及治疗反应。结果：2型糖尿病或糖尿病肾病可以合并多种非糖尿病肾损害，以各种类型的原发性及继发性肾小球疾病为主。原发性肾小球疾病常见病理类型有轻度系膜增生性肾小球肾炎、膜性肾病、IgA肾病和微小病变。这些患者具有以下不同于典型糖尿病肾病的特点：（1）糖尿病病程短于5年；（2）大量蛋白尿或肾功能不全时血压正常；（3）急性肾功能衰竭；（4）血尿明显。大部分肾病水平蛋白尿患者经糖皮质激素或糖皮质激素联合细胞毒类药物治疗后可完全缓解.结论：（1）2型糖尿病合并肾损害不等于糖尿病肾病；（2）2型糖尿病可以合并各种非糖尿病性肾损害；（3）当2型糖尿病伴肾脏受累者具有上述不符合糖尿病肾病特征时，应尽早行肾活检明确诊断；（4）在充分考虑患者 的临床特点、病理改变、严格控制血糖及血压的情况下，糖皮质激素或糖皮质激素联合细胞毒类药物治疗是安全有效的，可以改变患者的预后。

Non-diabetic renal disease in patients with type 2 diabetes mellitus

Objective To analyse the clinical and pathological characteristics of type 2 diabetic mellitus complicated with non-diabetic renal diseases. Methods twenty-nine type 2 diabetic patients complicated with non-diabetic renal disease were diagnosed by renal biopsies in our department from 1994 to 2001. Their histological changes were analyzed together with clinical findings and therapeutic effects. Results There were various types of renal disease, including primary and secondary glomerulopathy, complicated with type 2 diabetes mellitus. The common lesions were mild mesangial proliferative glomerulonephritis(7 cases), membranous nephropathy(5 cases), IgA nephropathy(4 cases) and minimal change disease(4 cases), etc. Superimposed renal disease was suspected in patients with a short history of type 2 diabetic mellitus less than 5 years, normal blood pressure unparalleled with massive proteinuria and renal failure, obvious hematuria and acute renal failure. Most of the patients who received corticosteroids or corticosteroids combined with cytotoxin drugs got remission. Conclusions(a) Many primary or secondary glomerulopathy may superimpose with type 2 diabetic mellitus or diabetic nephropathy.(b) Renal biopsy is helpful for the diagnosis when there is the clue mentioned above in type 2 diabetic patients.(c) Most of the patients with massive proteinuria can get remission after appropriate treatment, which will bring different prognosis.