The pathogenesis of diabetic nephropathy

Diabetic nephropathy is much in the course of more than 10 years of diabetes, proteinuria is the earliest, diabetic nephropathy pathogenesis is complex, has not been fully elucidated.Research materials said the pathogenesis of diabetic nephropathy is multiple factors, mainly has the following several aspects:

1, mechanical abnormal renal blood activities: in diabetic nephropathy, play a key role, and perhaps even initiating factors.

(1) high blood sugar, high within the glomeruli, high filtration state, across the capillary wall pressure increase, expand mesangial cells, epithelial cell foot process fusion, and produce dense droplets, glomerular epithelial cells become detached from the basement membrane.

Collagen type (2) the glomerular basement membrane Ⅳ messenger sugar nucleic acid increased, the thickening of basement membrane, the ultimate form of mesangial clouded, nodular lesions, and glomerular sclerosis.

(3) in the case of increased pressure, increase protein filtration, can precipitate in mesangial area and glomerular basement membrane, promote stromal hyperplasia, form a vicious cycle, and can cause nodular and clouded glomerular sclerosis.

2, hyperglycemia: diabetic nephropathy in closely related to high blood sugar, poor blood glucose control can accelerate the progress of diabetic nephropathy, good blood glucose control can obviously delay its progress.High blood sugar, glycosylation end-products of natural increase caused by mesangial cell proliferation and extracellular matrix increased, mesangial expansion and glomerular basement membrane thickening, etc.

3, genetic factors: most patients with diabetes ultimate not happen kidney disease changes, some long-term blood sugar control good also can appear in patients with diabetic nephropathy.Glucose transporter protein 1 (GLUT1) on glomerular mesangial cells is the main glucose transporter.Recent studies have found that people with diabetes between different individual GLUT1 menu of mesangial cells and regulating the differences are likely to be some patients are predisposed to kidney damage.And the occurrence of diabetic nephropathy also show the family condensation phenomenon, and in some patients with a family history of high blood pressure, diabetes, the incidence of diabetic nephropathy is significantly higher than that of without a family history of hypertension patients.In addition, between different ethnic groups there are differences in prevalence of diabetic nephropathy.It showed that the occurrence of diabetic nephropathy is associated with genetic factors.


4, high blood pressure, and there is no direct relationship between diabetic nephropathy in, but the original hypertension or blood pressure when in the course of the disease to microalbuminuria period after can accelerate the progress of diabetic nephropathy and the deterioration of renal function, increase the excretion of urine albumin.