@article{oai:niigata-u.repo.nii.ac.jp:00006615,
 author = {Nakamoto, Yasushi and Inomata, Shigeki and Takazakura, Eisuke and Yasuda, Tadashi and Neil, L. R. Tate},
 journal = {Acta medica et biologica, Acta medica et biologica},
 month = {Mar},
 note = {A total of 390 kidney specimens (361 biopsies and 29 autopsies) from 353 patients with diabetes mellitus were reviewed. There were 48 cases with IDDM (58 kidney specimens) and 305 cases with NIDDM (332 specimens). The diffuse and nodular lesions were graded by Gellman's criteria, and arteriolar hyalinosis by our previous criteria. We analyzed sequential features in the development of the diabetic renal injuries and compared them with IDDM and NIDDM. The diffuse lesion, which began to appear as segmental thickening of the mesangial area, was characterized by the deposition of strongly PAS-positive materials, most probably glycosylated serum proteins. As the diffuse lesion progressed to grades II and III, the small nodule was formed with the locally accentuated deposition of the glycosylated proteins. The blood flow of surrounding capillaries of the nodule frequently began to stagnate, and as long as the stagnation persisted, the capillary lumina were gradually enlarged and bulged with the eventual development of capillary microaneurysm filled with red blood cells. This sequence of events indicates that a segmentally turbulent intraglomerular circulation has occurred. The widened perinodular or perimesangial spaces with or without the capillary microaneurysm were slowly occupied again by the glycosylated proteins in a stratified pattern, ultimately leading to larger nodules. A few cases showed mesangial disintegration or mesangiolysis, but this did not result in the larger nodule, only to be recanalized. Fibrin cap was structurally identical to the capillary aneurysm, but lacked red blood cells in it. This difference seemed to be well explained by blood skimming processes; the former with accumulation of already skimmed plasma, and the latter with that of skimmed red blood cells. Thus, the segmental turbulence of glomerular circulation played an important role in the progression of diabetic glomerulosclerosis. This intraglomerular hemodynamic perturbation appeared to be enhanced by intraglomerular hypertension, especially in IDDM, and simultaneous hyalinosis of the afferent and efferent arterioles.},
 pages = {81--91},
 title = {Onset and Progression of Diabetic Glomerulosclerosis. A Pathogenetic Role of Segmentally Turbulent Glomerular Circulation.},
 volume = {38(Supplement)},
 year = {1990}
}