1型糖尿病における傍糸球体装置のT cell浸潤は糖尿病性腎症の発症に関与するか [in Japanese] T Cell Infiltration in the Juxtaglomerular Apparatus as an Indicator of Diabetic Nephropathy in Type 1 Diabetic Patients [in Japanese]
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Overt diabetic nephropathy (DN) develops in 20〜40% of Type 1 insulin-dependent diabetic patients (Type 1D). It is well known that hyperglycemia is a major risk factor for DN. Recently another factor such as renin-angiotensin system (RAS) is considered to be an important factor in renal extracellular matrix dynamics in diabetes. This study considers the frequency of juxtaglomerular apparatus (JGA) T cell infiltration in young Type 1 diabetic patients (10〜30 years old, 2〜20 years of duration of diabetes, albumin excretion rate<100μg/min) by immunohistochemical staining and examined whether there were renal structural or functional differences between Type 1D patients with and without JGA T cell infiltration. Out of 91 patients whose number of glomerulus or JGAs are enough for judgement of T cell infiltration, 37 cases showed positive staining (P), 40 cases showed negative staining (N) and 14 cases showed borderline staining for T cell infiltration. There was no significant difference between P and N groups in category of age, age of onset of Type 1D, gender, albumin excretion rate, glomerular filtration rate, HbAlc, mean blood pressure. Only the duration of Type 1D was significantly shorter in the P group compared to the N group. Vv (Mes/glom) was increased only in N group compared to normal. GBM width was increased in both P and n groups compared to normal, but there was no significant difference between two groups. Sv (PGBM/glom) and filtration surface per glomerulus was increased in the P group compared to N group and normal. JGA T cell infiltration was detected in 48% of young Type 1D which indicate that autoimmunity might affect the onset and the progress of DN. From the fact that the duration of Type 1D was shorter and the filtration surface was increased in the P group, we may conclude that the morphological changes at the early stage in the DN are the increase of filtration surface.
- Kitasato medicine
Kitasato medicine 30(6), 432-438, 2000-12-31