제 2형 당뇨병 환자에서 동반된 비당뇨병성 신질환의 임상 양상 = Clinical Characteristics of Non-diabetic Renal Diseasein Type 2 Diabetic Patients

다국어 초록 (Multilingual Abstract)

Background:Non-diabetic renal diseases are accompanied in 9-66% of type 2 diabetic patients and some clinical and laboratory findings are known as predictors of these non-diabetic renal disease. In Korea, however, there have been few studies on the clinical and pathologic findings of non-diabetic renal disease in diabetic patients. The purpose of this study was to explore the clinical, laboratory, and pathologic features of non-diabetic renal disease and to clarify the factors that could predict non-diabetic renal disease in type 2 diabetic patients.
Methods:The medical records of type 2 diabetic patients who were over 20 years old and underwent renal biopsy between January, 1994 and December, 2003, were retrospectively reviewed.
Results:A total of 56 patients were enrolled. Persistent hematuria (25.0%) was the leading reason for renal biopsy in type 2 diabetic patients, followed by sudden onset of nephrotic-range proteinuria (23.2 %), short duration (<10 years) of DM (23.2%), rapid deterioration of renal function (17.9%), and absence of diabetic retinopathy (8.9%). Renal biopsy revealed diabetic nephropathy (DN) in 20 patients (35.7%), non-diabetic renal disease (NDRD) in 33 patients (58.9%), and NDRD with concomitant DN in 3 patients (5.4%). The most common NDRD was membranous nephropathy, accompanied in 9 patients (16.1 %), followed by minimal change disease (10.7%), focal segmental glomerulosclerosis (8.9%). When the patients were divided into DN (20 patients) and NDRD (36 patients) groups, NDRD group had significantly shorter duration of DM, more patients with hematuria, and less patients with DM retinopathy. In contrast, there were no differences in age, sex, blood pressure, blood urea nitrogen, serum creatinine, albumin, and total cholesterol levels, 24 hr urinary protein and albumin excretion, creatinine clearance, and proportion of patients with DM neuropathy between the two groups.
Conclusion:There were significant differences in the duration of DM, the presence of hematuria, and the presence of retinopathy between DN and NDRD groups. Therefore, we must consider NDRD in type II DM patients with short duration of DM, hematuria or without retinopathy.

국문 초록 (Abstract)

목 적:제 2형 당뇨병 환자의 9-66%에서 비당뇨병성 신질환이 동반되는 것으로 보고되는데, 국내에서는 당뇨병 환자에서의 비당뇨병성 신질환에 대한 보고가 거의 없는 실정이다. 이에 본 연구자는 제 2형 당뇨병 환자에서 동반된 비당뇨병성 신질환의 임상 양상과 이의 예측 인자를 알아보기 위해 당뇨병 환자 중 신조직 검사를 시행한 환자를 대상으로 임상적 특성 및 조직병리학적 소견을 분석하였다.
방 법:연세대학교 의과대학 세브란스병원에서 1994년 1월부터 2003년 12월까지 신조직 검사를 시행받은 제 2형 20세 이상의 당뇨병 환자를 대상으로 연령, 성별, 당뇨병 유병 기간, 혈압, 혈청생화학 검사, 24시간 요단백과 요알부민 배설량, 혈뇨의 유무, 당뇨병성 망막병증 및 신경병증의 유무, 그리고 신조직 검사를 시행한 이유와 결과를 분석하였다.
결 과:대상 환자는 총 56명이었으며, 신조직 검사를 시행한 이유로 혈뇨의 동반이 14명 (25.0%)으로 가장 많았고, 신증후군 범위의 단백뇨의 돌연한 발생 13명 (23.2%), 신부전증이나 단백뇨를 동반하면서 당뇨병 유병 기간이 10년 미만인 경우 13명 (23.2%), 급격한 신기능의 악화 10명 (17.9%), 그리고 신부전증이나 단백뇨를 동반하면서 당뇨병성 망막병증이 없었던 경우가 5명 (8.9%)이었다. 신조직의 병리학적 소견으로는 당뇨병성 신병증이 20명 (35.7%)으로 가장 많았고, 비당뇨병성 신질환 중에서는 막성 사구체신염 (membranous nephropathy)이 9명 (16.1%), 미세변화 질환 (minimal change disease) 6명 (10.7%), 국소성 분절성 사구체경화증 (focal segmental glomerulosclerosis) 5명 (8.9%)의 순이었다. 대상 환자를 당뇨병성 신병증군 (20명, DN군)과 비당뇨병성 신질환군 (36명, NDRD군)으로 나누어 분석한 결과, 양군간에 연령, 성별, 혈압, 혈청 크레아티닌, 총 단백, 알부민, 총 콜레스테롤, 당화혈색소, 24시간 요단백과 요알부민 배설량, 그리고 당뇨병성 신경병증의 유무에는 통계학적 차이가 없었다. 그러나, 당뇨병의 유병 기간은 NDRD군이 4.5±0.9년으로 DN군의 10.3±1.3년에 비해 의의있게 짧았다. 또한, 혈뇨를 동반한 환자는 NDRD군에서 26명 (72.2%)으로 DN군의 4명 (20.0%)에 비해 의의있게 많았던 반면, 당뇨병성 망막병증을 동반한 환자 비율은 NDRD군에서 53.8% (7/13)로 DN군의 93.3% (14/15)에 비해 통계학적으로 유의하게 적었다.

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