Kengo Furuichi1, Yukio Yuzawa2, Miho Shimizu1, Akinori Hara1, Tadashi Toyama1, Hiroshi Kitamura3, Yoshiki Suzuki4, Hiroshi Sato5, Noriko Uesugi6, Yoshifumi Ubara7, Satoshi Hisano8, Yoshihiko Ueda9, Shinichi Nishi10, Hitoshi Yokoyama11, Tomoya Nishino12, Kentaro Kohagura13, Daisuke Ogawa14, Koki Mise14, Yugo Shibagaki15, Kenjiro Kimura16, Masakazu Haneda17, Hirofumi Makino14, Seiichi Matsuo18, Takashi Wada19. 1. Division of Nephrology, Kanazawa University Hospital, Ishikawa, Japan. 2. Department of Nephrology, Fujita Health University Hospital, Aichi, Japan. 3. Department of Pathology, Clinical Research Center, National Hospital Organization Chiba East National Hospital, Chiba, Japan. 4. Health Administration Center, Niigata University, Niigata, Japan. 5. Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan. 6. Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. 7. Nephrology Center, Toranomon Hospital, Tokyo, Japan. 8. Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 9. Department of Diagnostic Pathology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan. 10. Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Hyogo, Japan. 11. Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan. 12. Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan. 13. Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus School of Medicine, Okinawa, Japan. 14. Department of Diabetic Nephropathy, Okayama University, Okayama, Japan. 15. Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan. 16. Tokyo Takanawa Hospital, Tokyo, Japan. 17. Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan. 18. Division of Nephrology, Department of Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. 19. Division of Nephrology, Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan.
Abstract
Background: The clinical and pathologic manifestations of nephropathy due to type 2 diabetes are diverse, but large-scale pathologic studies with long-term observations are limited. Methods: Kidney biopsies and clinical data of 600 patients with type 2 diabetes were collected retrospectively from 13 centres across Japan. Thirteen pathologic findings (nine glomerular lesions, two interstitial lesions and two vascular lesions) were clearly defined and scored. Results: During the observation period, there were 304 composite kidney events [dialysis, doubling of creatinine or reduction of estimated glomerular filtration rate (eGFR) by half], 31 instances of chronic kidney disease (CKD) G5D, 76 cardiovascular events and 73 deaths. The mean observation period was 72.4 months. The distribution of CKD heat map categories for the 600 patients was 103 green or yellow, 149 orange and 348 red. Even in the cases in the green and yellow category, diffuse lesions (81.6%), polar vasculosis (42.6%) and subendothelial space widening (35.1%) were commonly detected. Cox proportional hazard analysis revealed that the presence of nodular lesions [hazard ratio (HR) 21.1, 95% confidence interval (CI) 5.3-84.6], exudative lesions (HR 5.1, 95% CI 1.3-20.3) and mesangiolysis (HR 7.6, 95% CI 2.0-28.8) in cases in the green and yellow category were associated with significantly great impact on composite kidney events after adjustment for clinical risk factors. Conclusions: This nationwide study on kidney biopsy of 600 cases with type 2 diabetes revealed that pathologic findings (presence of nodular lesions, exudative lesions and mesangiolysis) were strong predictors of kidney events in low-risk patients.
Background: The clinical and pathologic manifestations of nephropathy due to type 2 diabetes are diverse, but large-scale pathologic studies with long-term observations are limited. Methods: Kidney biopsies and clinical data of 600 patients with type 2 diabetes were collected retrospectively from 13 centres across Japan. Thirteen pathologic findings (nine glomerular lesions, two interstitial lesions and two vascular lesions) were clearly defined and scored. Results: During the observation period, there were 304 composite kidney events [dialysis, doubling of creatinine or reduction of estimated glomerular filtration rate (eGFR) by half], 31 instances of chronic kidney disease (CKD) G5D, 76 cardiovascular events and 73 deaths. The mean observation period was 72.4 months. The distribution of CKD heat map categories for the 600 patients was 103 green or yellow, 149 orange and 348 red. Even in the cases in the green and yellow category, diffuse lesions (81.6%), polar vasculosis (42.6%) and subendothelial space widening (35.1%) were commonly detected. Cox proportional hazard analysis revealed that the presence of nodular lesions [hazard ratio (HR) 21.1, 95% confidence interval (CI) 5.3-84.6], exudative lesions (HR 5.1, 95% CI 1.3-20.3) and mesangiolysis (HR 7.6, 95% CI 2.0-28.8) in cases in the green and yellow category were associated with significantly great impact on composite kidney events after adjustment for clinical risk factors. Conclusions: This nationwide study on kidney biopsy of 600 cases with type 2 diabetes revealed that pathologic findings (presence of nodular lesions, exudative lesions and mesangiolysis) were strong predictors of kidney events in low-risk patients.