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中华肾病研究电子杂志 ›› 2019, Vol. 08 ›› Issue (03) : 132 -137. doi: 10.3877/cma.j.issn.2095-3216.2019.03.007

所属专题: 指南与规范 文献 指南共识

综述

糖尿病肾病规范化诊断研究进展
田冬琴1, 刘开翔2, 占志朋2, 谢席胜2,()   
  1. 1. 646000 西南医科大学临床医学院
    2. 637001 川北医学院第二临床医学院
  • 收稿日期:2018-05-11 出版日期:2019-06-28
  • 通信作者: 谢席胜
  • 基金资助:
    四川省中医药管理局中医药科研专项(2018JC037); 四川省卫计委科研专项(18PJ367)

Progress in standardized diagnosis of diabetic kidney disease

Dongqin Tian1, Kaixiang Liu2, Zhipeng Zhan2, Xisheng Xie2,()   

  1. 1. Southwest Medical University School of Clinical Medicine, Luzhou 646000
    2. Department of Nephrology, Nanchong City Central Hospital, North Sichuan Medical College, Nanchong 637001; Sichuan Province, China
  • Received:2018-05-11 Published:2019-06-28
  • Corresponding author: Xisheng Xie
  • About author:
    Corresponding author: Xie Xisheng, Email:
引用本文:

田冬琴, 刘开翔, 占志朋, 谢席胜. 糖尿病肾病规范化诊断研究进展[J/OL]. 中华肾病研究电子杂志, 2019, 08(03): 132-137.

Dongqin Tian, Kaixiang Liu, Zhipeng Zhan, Xisheng Xie. Progress in standardized diagnosis of diabetic kidney disease[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2019, 08(03): 132-137.

糖尿病肾脏疾病(DKD)是糖尿病的严重并发症,也是引起终末期肾病(ESRD)的常见原因。DKD的临床诊断通常有赖于糖尿病病史、尿白蛋白特点、有无视网膜病变及有无活动性尿沉渣等指标进行综合判断。但越来越多的研究提示了目前此临床诊断方法的高误诊率,本文就DKD的诊断进展进行了综述。

Diabetic kidney disease (DKD) is a serious complication of diabetes mellitus, and is common cause of end-stage renal disease (ESRD). The clinical diagnosis of DKD usually depends on the history of diabetes, the characteristics of urinary albumin, the presence or absence of retinopathy, and the presence or absence of active urine sediment, etc. However, more and more studies have suggested the high misdiagnosis rate of this clinical diagnosis method. This paper reviewed the progress of DKD diagnosis.

表1 2014年日本DKD联合委员会关于DKD分期a[25]
表2 糖尿病肾病的肾小球病变分级标准[37]
表3 糖尿病肾病的间质和血管病变评分[37]
图1 鉴别糖尿病肾病与非糖尿病肾病的JDB方程
表4 糖尿病肾病与其他结节样病变的鉴别[44]
疾病 临床表现 光镜 免疫荧光 电镜
糖尿病肾病 较长的糖尿病病程 系膜结节硬化,PAS(+),嗜银(+) 硬化结节内IgG线样沉积,伴或不伴IgM、C3沉积 系膜扩张,基底膜弥漫性增厚,非特异性纤维沉积
膜增生性肾小球肾炎 慢性肾炎,肾病综合征,高血压,低补体血症 系膜结节样硬化,系膜插入,双轨征,PAS(+),嗜银(+) 多种免疫球蛋白和补体成分颗粒样沉积 Ⅰ型内皮下,Ⅱ型膜内带状或结节状,Ⅲ型上皮下电子致密物沉积
肾淀粉样变性 慢性感染,系统性淀粉样变性,恶性淋巴组织增生,家族遗传 系膜结节样硬化,刚果红(+) λ轻链在系膜、基底膜、小管间质、血管壁中沉积 淀粉样纤维(排列紊乱,不分枝,直径9~11 nm)
单克隆免疫球蛋白/轻链沉积病 老年人,浆细胞病,特发性 系膜结节样硬化,PAS(+),嗜银(-) 单克隆κ轻链在肾小球基底膜、肾小管基底膜中沉积 泥沙状或颗粒状沉积
Ⅲ型胶原病 持续性蛋白尿,肾病综合征 系膜结节样硬化,PAS弱(+) Ⅲ型胶原沉积 平行排列的胶原纤维(直径100 nm)
纤连蛋白肾病 罕见,常染色体显性遗传,肾病综合征 系膜结节样硬化,PAS(+),刚果红(-) 纤连蛋白沉积 短纤维(直径10~14 nm)颗粒状沉积
冷球蛋白血症 蛋白尿,肾病综合征,高血清冷球蛋白,恶性淋巴组织增生 毛细血管内增生,炎细胞浸润,毛细血管内血栓形成,结节样肾小球硬化,PAS(+) 单克隆或多克隆免疫球蛋白(IgG、IgM、C3)和内风湿因子沉积 有序的电子致密物沉积(微管状,直径30 nm)
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