Orginal Publication Date
MCV/Q, Medical College of Virginia Quarterly
Why should the mesangial cells be irritated? We recently observed in some diabetics black deposits beneath and on both sides of the basement membrane. These appear quite similar to deposits seen in and around the basement membrane in glomerulonephritis and in lupus nephritis. I do not know for sure what they are, but theory says that in glomerulonephritis they probably represent antigen-antibody complexes. There is some evidence to support this. One would assume that in diabetes they might be the same thing. Or they might be some other atypical plasma protein which results from the abnormal pattern of diabetic metabolism. I do not know. I believe this substance may be trapped by the basement membrane. It may be an abnormal substance that is trapped, or it may be an abnormal basement membrane that traps it. As this material is trapped, it is irritating to the mesangial cells and causes them to proliferate and secrete more of the basement membrane-like material. This material gradually fills up the glomeruli, and causes them to become non-functional, ultimately leading to uremia and death. It is of great interest also that these same processes are observed in experimentally-produced diabetes in the dog, a non-hereditary form of diabetes. This would seem to favor a metabolic rather than a genetic origin for the vascular defect.
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