糖 尿 病28巻8.号(1985) 1 320. II. Arteriolosclerosis Note hyaline teriole 2 type at afferent right a 3 IV. Nodular Showing lesion. some nodules ar- thickning. an in lipo ~ in a HE. ~ 320. Kimmelstiel-Wilson's glomerulus. bottom. diabetic Showing matrix HE. of glomerular side Mesangial (Diffuse sclerosis) sangial of the III. 320. only. arteriolosclerosis HE. increase glomerular in 4 V. Showing glomerulo- ~ nized me- End-stage almost and kidney. all marked HE. ~ glomerulus interstitital 64. hyali- fibrosis. lobule. れ る もの で 病 変 は 一 部 の メサ ンギ ウ ムの 肥厚 を 示す の み の 軽 度 の もの か ら,ほ ぼ す べ て の 糸 球 体 の メサ ン ギ 腎の組織学的変化 1.変 II.細 III.メ IV.明 V.糸 化 の み られ な い も の ウ ムの 肥 厚 と初 期 結 節 形 成 を もつ 高 度 な も の ま で あ 小動脈硬化のみ り,I型 か ら,V型 あ る.す な わ ち 弱 拡 大 で は 結 節 が 見 つ か らな い もの で サ ンギ ウ ムの 肥 厚 あ る.IV型(3)は らか な 糸 球 体 結 節 性 病 変 を 認 め る も の. 球 体 硝 子 化,間 質 線 維 増 生 な ど 著 しい も の 1)はlipo-hyaline型 の細小動脈硬化症のみ み られ 線維 の 増 生 の 著 しい もの で あ る. 拡 大 で探 して も糸 球 体 メサ ンギ ウ ムの 肥 厚 の み ら れ な い も の で あ る,III型(2)メ ギ ウ ム の 肥 厚 はWHOの 類2)で はdiHhse 4)肉 限 的 に}よ萎 縮 腎 の所 見 を 呈 して い る もの で,光 顕 で は 糸 球体 の 硝 了化,間 質 は 変 化 の み られ な い も の で あ る.II型(Flg. る も の で,強 明 らか な 糸球 体 結 節 性 病 変 が み られ る もの で,結 節 は 弱拡 大 で容 易 に認 め られ る もの で あ る.v型( (end-stage) 1型 の 中 で は 最 も幅 の 広 い組 織 変化 で diabetic サ ン 糖尿病性糸球体硬化症の 分 glomerulosclerosisに 入れ ら 882 結 果 と 考按 1.腎 の組 織 学 的 変 化 腎 の 組織 学 的変 化 の結 果 を 比 較 す る とTable 1の

Table 1 Incidences of glomerular lesions in 1960's vs. 1970's

5 The cases having disease duration more than 16 years increased remarkably in the 1970's thickning or nodular lesion and dying in the 6 th or 7 th decades in the 1970 's 6 Forty-seven % cases showing mesangial

Table 2 Incidences of causes of death in 1960's. vs. 1970's. 7 Coronary heart disease, cerebrovascular disease and renal disease are common in both decades. 2) Churg, J., Sobin, L.H.: Diabetic glomerulosclerosis. Renal disease. Classification and atlas of glomerular disease. Igaku-shoin. Tokyo, New York, (1983) p 226-239. 4) Deckert, T., Poulsen, L.E., Larsen, M.: Pro- gnosis of diabetics with diabetes onset before the age of thirtyone. II. Factors influencing the prognosis. Diabetologia 14: 371-377 (1978) 5) Ross, H., Bernstein G., Rifkin, H.: Relationship of metabolic control of diabetes mellitus to long-term complications "Diabetes mellitus. Theory and practice". Ellenberg, M., Rifkin, H. ed. 3rd ed. Medical examination pu- blishing Co. INC. An excerpta medica co-

mpany. New York, (1983) p 907-926. 6) Mauer, S.M., Steffes, M. W., Brown, D.M.: The kidney in diabetes. Am. J. Med. 70: 603-612 (1981) 7) Takasakura, E., Nakamoto, Y.: Onset and progression of diabetic glomerulosclerosis. A prospective study based on serial renal biopsies. Diabetes 24: 1-9 (1975) 8) Gundersen, H.J.G., Osterby, R.: Glomerular size and structure in diabetees mellitus. 11. Late abnormality. Diabetologia 13: 43-38 (1977) 9) Ellenberg, M., Rifkin, H.: Diabetic renal disease. "Diabetes mellitus. Theory and practice." Ellenberg, M., Rifkin, H.ed. 3 rd. ed. Medical examination publishing Co. INC. An excerpta medica company. New York, (1983) p 756-776. 10) Osterby, R.: Morphometric studies of the peripheral glomerular basement membrane in early juvenile diabetes. 1. Development of initial basement membrane thickning. Diabetologia 8: 84-92 (1972) 11) Mauer, S.M., Barbosa, J., Vernier, R.L.: Development of diabetic vascular lesion in normal kidneys transplanted into patients with diabetes mellitus. N. Engl. J. Med. 295: 12) Mauer, S.M., Ste iif~s, M.W., Connett, j., Najarian,,J.S., Sutherland, D.E.R., Barbosa, J.: The development of lesions in the glomerular basement membranes and mesangium after transplantation of normal kidneys to diabetic patients. Diabetes 32: 948-952 (1983) 13) Stelies, M.W., Brown, D.M., Mauer, S.M.: Diabetic glomerulopathy following unilateral nephrectomy in the rat. Diabetes 27: 35-41 (1978) 14) Deckert, T., Poulsen, J.E., Larsen, M.: Prognosis of diabetics with diabetes onset before the age of thirtyone. I. Survival, causes of death, and complications. Diabetologia 14: 363-370 (1978) 16) Paulmbo, P.J., Elenback, L.R., Chu, C., Connoly, D.C., Kurland, L.T.: Diabetes mellitus: Incidence, prevalence, survivorship, and causes of death in Rochester, Minnesota, 1945-1970. Diabetes 25: 566-573 (1976) 17) Sasaki, A., Uehara, M., Horiuchi, N., Hasegawa, K.: A long-term follow-up study of Japanese diabetic patients: Mortality and causes of death. Diabetologia 25: 309-312 (1983)

Abstract Comparison of Autopsy Cases of Diabetes Mellitus in Two Decades, the 1960 s v.s. the 1970 s, with Special Reference to Diabetic Glomerulosclerosis Yasuko Kondo Department of Pathology, Keio University School of Medicine Eighty-one autopsy cases examined during the 1960 s and 209 autopsy cases examined during the 1970 s were studied. The severity of diabetic glomerulosclerosis and its relation to the duration of diabetes, age at death and causes of death were investigated. The following criteria were used for the severity fo renal changes : I : minimal change, II : arteriolosclerosis only, III : mesangial thickening, IV : nodular lesion and V : end-stage kidney. 1) Renal lesions were seen in 92% and 91% in of cases from the 1960 s and 1970 s, respectively. 2) The severity of diabetic glomerulosclerosis was well correlated with the duration of diabetes in the cases from the 1970 s, but such a relationship was not remarkable in the cases from the 1960 s. This was mainly due to the fact that only a few cases had had a disease duration of more than 16 years. In the cases from the 1970 s mesangial thickening mostly developed in cases having a disease duration of less than 15 years. Nodular lesions were mostly seen in cases having a disease duration of 16 to 25 years. 3) Cases dying in their 2nd or 3rd decade and having no glomerular change were seen in the 1960 s but not in the 1970 s. The number of cases showing mesangial thickening or nodular lesion, and dying in their 6th or 7th decade increased remarkably in the 1970 s. This was probably due to an increase in the number of long-term survivors. 4) As causes of death, infectious diseases were less frequent in the cases from the 1970 s than in those form the 1960 s. Deaths from malignancy increased during that period, although the death rate from malignancy was similar to that of autopsied cases from the general population. Coronary heart disease, cerebrovascular disease and renal disease were common in both decade3. As long-term survivors of diabetes increased, renal disease became more important as a cause of death. J. Japan Diab. Soc. 28(8) : 881.887, 1985