糖尿病肾病2014年11月PPT课件.pptx

糖尿病肾病北京协和医院肾内科李学旺2014年11月 2014/10/12目录2014/10/12糖尿病肾病的定义2014/10/12糖尿病肾病是一临床综合征，指糖尿病患者在3—6个月的时间内至少有两次测得微量白蛋白尿。早期的糖尿病肾病表现为微量白蛋白尿，后期表现为大量白蛋白尿。（300 mg/ d；A/CR 300 mg/g 或34 mg/mmol为界限) 。糖尿病肾病通常会伴高血压、进展性尿蛋白量增加和肾功能减退。美国2型糖尿病患者中合并CKD的比例可达40% ，中国64%数据来自1999-2004年第4次美国国家健康与营养调查研究对象：年龄≥20岁的2型糖尿病患者，n=1462研究对象：上海市区年龄≥30岁的2型糖尿病患者，n=1009Koro CE, et al. Clin Ther;2009. 31:2608-2617 Lu B, et al. J Diabetes its Complications. 2008. 96-103 2014/10/12糖尿病肾病在终末期肾衰竭中的比例（必威体育精装版资料） 2014/10/12对糖尿病和非糖尿病所致ESRD发病率和患病率增长的预测2014/10/12USRDS: 2003 ADR. AJKD 42 (Suppl 5):S55, 2003不典型糖尿病肾损害意大利的Fioretto等提出①严重的肾小管间质病变②严重的与大血管动脉粥样硬化相关的肾小动脉玻璃样变③系膜区无或仅轻度增宽，但肾小球球性硬化比例超过25％1.Fioretto P, Mauer M, et al. Patterns of renal injury in NIDDM patients with microalbuminuria. Diabetologia, 1996, 39: 1569-1576.2.徐鹏杰，李航，温昱冰，李学旺 中华肾脏病杂志,10/12肾小球轻微病变基础上，又包含以下任意一项：非糖尿病肾病 (non-diabetic renal disease，NDRD)1.Eberhard R, Stephan RO. Nephropathy in patients with type 2 diabetes mellitus. NEJM, 1999, 341(15): 1127-1133.2.Eberhard R. Diabetic nephropathy. Saudi J Kidney Dis Transplant, 2006, 17(4): 481-490.2014/10/12回顾性研究：8%-81% 小样本前瞻性研究：20%-30% Renal Biopsy Findings in Diabetes Sharma SG. Etal: Clin J Am Soc Nephrol 8: 1718–1724, October, 2013 The Largest Single-Center Study of Renal Biopsy in Patients With Diabetes620 patients who underwent kidney biopsy —227（37%）DN alone —226（36%）NDRD alone —164（27%）DN +NDRD Diabetic nephropathy with superimposed IgA nephropathy (A) A glomerulus with moderate nodular mesangial sclerosis and glomerular basement membrane thickening exhibits mild segmental mesangial hypercellularity (staining with periodic acid–Schiff). (B) A representative glomerulus shows mesangial expansion by increased mesangial cell number and matrix (staining with hematoxylin and eosin)(C) Immunofluorescencstaining for IgA shows global mesangial immune deposits within the expanded mesangiume . (D) By electron microscopy, there is a paramesangial electron dense deposit typical of IgA nephropathy associated wi