(365. (tubular basement membrane) [2,3] (Bowan's capsule) [4] [5] 1. Kimmelstiel-Wilson nodules 92 (microaneurysm) (mesangial expansion)

Transcription

1 (USRDS) 2004Kimmelstiel-Wilson (Annual Data Report presents data on end-stage renal disease) [1] 2002 (1548 ) 1. (glomerular basement mem- thickening) ( brane ) 2002 (365 ) (mesangial expansion) (38.7%) (ECM, extracellular matrix) periodic acid-schiff(pas) 5 7 ( d i f f u s e glomerulosclerosis) 3. (glomerular basement membrane) 25 35% (tubular basement membrane) [2,3] 8 10% (Bowan's capsule) [4] (linear pattern) IgG albumin 80% [5] 1. Kimmelstiel-Wilson nodules 92 (microaneurysm) (mesangial expansion) (nodular nephrosclerosis) 2. (afferent ) and efferent glomerular arteriolar hyalinosis) (immunoglobulin, complement, fibrinogen and albumin) (hypertrophy) ( ) 3. (tubular basement membrane [8,9,10,11] ( thickening) (interstitial expansion)

2 (global sclerosis) 1. (hyaline caps hyaline exudative lesions in the glomerular subendothelial space) (silent) 2. (capsular drop) (e.g. basement membrane thickening, mesangial expansion) 20 µg/min ( 30 mg/day) [11] ( ) (microalbuminuria) 7 (basement membrane thickening, mesangial expansion) µg/min ( mg/day) [12] [16,17] ( (e.g. membranous nephropathy, 400% 500% ) minimal lesion nephropathy, mesangial proliferative (30%) [18] glomerulonephritis, and chronic GN) [13,14] (overt diabetic nephropathy with clinical proteinuria) 77% 23% [14] 40% [15] (hyperfiltration) % 25 (albumin excretion rate) ( 1) ( 5 10 ) (Pima Indians) (hypertrophy-hyperfunction) 30% [19]

3 1. Timed collection 24-hr collection Spot collection (overnight) (µg/min) (mg/24 hr) (µg/mg Cr) Normoalbuminuria Microalbuminuria Proteinuria [20] ( ) [21] (Diabetes Complications (glomerular basement membrane and Control Trial) thickening) (progression) [22] ( UK Prospective Diabetes Study UKPDS 25% (microvascular complication)) [23] 20 (hemodynamic) 200 µg/min ( mg/day) (glomerular hyperfiltration) [24] 77% 23% (genetic) [14] 83% [25] (1) [26] (2) TGF- angitension-ii protein kinase (3) (4) C (PKC) glycosylation products aldose-reductase (5) endothelin prostaglandin

4 95% (microalbuminuria) [6] ( [16,17] ) DCCT UKPDS [27] 130/80 mmhg (angiotensin converting enzyme inhibitors ACEI) ( II (Angiotensin Receptor blocker 25% 60% ARB) [7]) [28,29] ACEI ( (ADA) RBC cast) (progression) 25% (microvascular complication) (CDA) ACEI (normoalbuminuria) ( ) (130/80 mmhg) GFR (National Kidney Foundation) ACEI (Cr) 1.5 mg/ (American Diabetes Association; ADA) dl 5 ( ) (nephropathy) [30,31] (retinopathy) (neuropathy) [32] DCCT UKPDS (DCCT) (UKPDS) (NSAID) (aminoglycoside)

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6 26. Freedman BI, Tuttle AB, Spray BJ: Familial predisposition to nephropathy in African-Americans with non-insulin-dependent diabetes mellitus. Am J Kidney Dis 1995; 25: Chantrel F, Bouiller M, Kolb I, et al: Antihypertensive treatment in type 2 diabetes and diabetic nephropathy. Nephrologie 2000; 21: Ruggenenti P, Perna A, Gherardi G, et al: Chronic proteinuric nephropathies: outcomes and response to treatment in a prospective cohort of 352 patients with different patterns of renal injury. Am J Kidney Dis 2000; 35: Chan JC, Ko GT, Leung DH, et al: Long-term effects of angiotensin-converting enzyme inhibition and metabolic control in hypertensive type 2 diabetic patients. Kidney Int 2000; 57: Pijls LT, de Vries H, Donker AJ, et al: The effect of protein restriction on albuminuria in patients with type 2 diabetes mellitus: a randomized trial. Nephrol Dial Transplant 1999; 14: Hansen HP, Christensen PK, Tauber-Lassen E, et al: Low protein diet and kidney function in insulin dependent diabetic patients with nephropathy. Kidney Int 1999; 55: Kasiske BL, Lakatua JD, Ma JZ, et al: A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function. Am J Kidney Dis 1998; 31: Parving H-H, Andersen AR, Smidt UM: Early and aggressive antihypertensive treatment reduces the rate of decline in kidney function in diabetic nephropathy. Lancet 1983; 1: Lewis EJ, Hunsicker LG, Bain RP, Rohde RD: The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 1993; 329: