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New ultrastructural approach to the pathogenesis of diabetic glomerulosclerosis

Acta Diabetologica Latina, ISSN: 0001-5563, Vol: 11, Issue: 4, Page: 283-295
1974
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The authors have carried out an ultrastructural investigation on glomerular capillaries in animals (6 spiny mice) and human individuals (5 healthy and 25 diabetic subjects). They studied the ratio existing in the glomerular capillaries, of actively filtering zones (af) and non-filtering ones (nf). A remarkable similarity was found, from this point of view, between healthy human individuals and healthy mice. On the contrary, this ratio suffered obvious and progressive modifications in patients with juvenile diabetes mellitus who developed diabetic glomerulosclerosis (DG). Reversal of this ratio characterizes the late phases of diabetic glomerulosclerosis. The authors emphasize the role played by this process in the reduction of GFR which occurs in the late periods of DG. The reduction of RPF seems to depend particularly on the narrowing of glomerular capillaries. Both the narrowing of the glomerular capillaries and the separation of the endothelial layer from the capsular space, are - in the authors' opinion - consequences of increased endothelial permeability in the renal glomerulus. The authors suggest the hypothesis of a precocious and constant alteration of endothelia during the diabetic disease. This seems to supply an explanation for the ubiquity, the evolutive character and the irreversibility of diabetic microangiopathy. © 1974 Il Ponte.

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