关键词: 糖尿病肾病, 系膜增生性病变, 估算的肾小球滤过率, 预后

Abstract: Ｏｂｊｅｃｔｉｖｅ：To investigate the clinicopathological features and prognosis of patients with mesangial proliferative diabetic nephropathy，and analyze the factors affecting estimated glomerular filtration rate slope.
Ｍｅｔｈｏｄｏｌｏｇｙ：Among patients with type 2 diabetes mellitus and diagnosed as diabetic nephropathy by renal biopsy at the National Clinical Medical Research Center for Kidney Diseases from January 2006 to January 2020，patients presenting with pathologic manifestations of mesangial proliferative lesions were included and retrospective studied. According to the quartiles of the dccline rate in estimated glomerular filtration rate（ΔeGFR），they were divided into group Q1～Q4. The clinicopathological data and prognosis differences in the four groups were compared. According to the KDIGO guidelines，rapid decline in renal function was defined as ΔeGFR>5 mL／（min·1.73 m2·year），and the factors influencing the rate of rapid decline in renal function and its impact on prognosis were analyzed.
Ｒｅｓｕｌｔｓ：Of the 183 patients who met the inclusion criteria，76 （41.5%） were male with a mean age of 47.8±9.2 years. At the time of renal biopsy，patients with more rapid ΔeGFR had a higher proportion of peripheral neuropathy，higher baseline urine protein，blood urea nitrogen，serum creatinine，glycosylated hemoglobin（HbA1c） levels，and lower serum albumin and calcium levels （P<0.05）. Also they had a more severe mesangial proliferative lesions （P=0.005），higher interstitial inflammation score （P=0.029） and higher interstitial fibrosis and renal tubular atrophy score （P=0.029）. Baseline blood calcium，baseline HbA1c，and interstitial inflammation score of kidney were independent predictors of rapid decline in renal function. Model equation for predicting rapid decline in renal function: logit （rapid decline）=0.876×interstitial inflammation-4.122×blood calcium+0.347×HbA1c+4.778 （AUC=0.736，95%CI 0.645～0.828，P<0.001）.
Ｃｏｎｃｌｕｓｉｏｎ：Rapid progression of renal function in patients with mesangial proliferative diabetic nephropathy correlates with renal interstitial inflammation scores，baseline serum calcium，and HbA1c levels. It suggests that the control of blood glucose and renal inflammation may help to delay the progression of renal function in the patients.

Key words: diabetic nephropathy, mesangial proliferation, estimated glomerular filtration rate, prognosis