Tatsumi Moriya1, Kazuki Omura2, Madoka Matsubara3, Yuki Yoshida3, Kei Hayama3, Motoshi Ouchi4. 1. Health Care Center, Kitasato University, Sagamihara, Kanagawa, Japan moriy@kitasato-u.ac.jp. 2. Omura Clinic, Shizuoka, Shizuoka, Japan. 3. Health Care Center, Kitasato University, Sagamihara, Kanagawa, Japan. 4. Department of Pharmacology and Toxicology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan.
Abstract
OBJECTIVE: This study investigated the association between renal histology, as assessed by morphometric analysis using light (LM) and electron (EM) microscopy, and changes in urinary albumin excretion (UAE) and glomerular filtration rate (GFR) in Japanese people with type 2 diabetes in the early stages of diabetic nephropathy. RESEARCH DESIGN AND METHODS: We performed percutaneous renal biopsies in 29 patients with type 2 diabetes (22 men, mean ± SD age 49 ± 10 years and GFR 119 ± 27 mL/min/1.73 m2, with 15 normoalbuminuric [UAE <20 μg/min] and 14 microalbuminuric [UAE 20-200 μg/min]) to clarify which histological factors were associated with changes in UAE and GFR during 8.0 ± 3.5 years' follow-up. Glomerular structural changes including mesangial volume fraction [Vv(Mes/glom)] were estimated using EM, whereas the index of arteriolar hyalinosis (IAH) score was assessed by LM. Patients underwent annual measurement of GFR using iohexol injection with simultaneous urine collections for UAE. RESULTS: Vv(Mes/glom) was negatively correlated with baseline and follow-up GFR but not with UAE. The IAH score was positively correlated with UAE and negatively correlated with GFR at follow-up, but it was not correlated with either UAE or GFR at baseline. GFR at follow-up was significantly decreased from baseline in patients with IAH scores ≥2.0 and significantly lower than in patients with IAH scores <2.0. Patients with IAH scores <2.0 showed no significant change in GFR during follow-up. CONCLUSIONS: Arteriolar hyalinosis is an additional histological predictor for albuminuria increase and GFR decline in normo- and microalbuminuric Japanese people with type 2 diabetes.
OBJECTIVE: This study investigated the association between renal histology, as assessed by morphometric analysis using light (LM) and electron (EM) microscopy, and changes in urinary albumin excretion (UAE) and glomerular filtration rate (GFR) in Japanese people with type 2 diabetes in the early stages of diabetic nephropathy. RESEARCH DESIGN AND METHODS: We performed percutaneous renal biopsies in 29 patients with type 2 diabetes (22 men, mean ± SD age 49 ± 10 years and GFR 119 ± 27 mL/min/1.73 m2, with 15 normoalbuminuric [UAE <20 μg/min] and 14 microalbuminuric [UAE 20-200 μg/min]) to clarify which histological factors were associated with changes in UAE and GFR during 8.0 ± 3.5 years' follow-up. Glomerular structural changes including mesangial volume fraction [Vv(Mes/glom)] were estimated using EM, whereas the index of arteriolar hyalinosis (IAH) score was assessed by LM. Patients underwent annual measurement of GFR using iohexol injection with simultaneous urine collections for UAE. RESULTS: Vv(Mes/glom) was negatively correlated with baseline and follow-up GFR but not with UAE. The IAH score was positively correlated with UAE and negatively correlated with GFR at follow-up, but it was not correlated with either UAE or GFR at baseline. GFR at follow-up was significantly decreased from baseline in patients with IAH scores ≥2.0 and significantly lower than in patients with IAH scores <2.0. Patients with IAH scores <2.0 showed no significant change in GFR during follow-up. CONCLUSIONS:Arteriolar hyalinosis is an additional histological predictor for albuminuria increase and GFR decline in normo- and microalbuminuric Japanese people with type 2 diabetes.
Authors: Helen C Looker; Michael Mauer; Pierre-Jean Saulnier; Jennifer L Harder; Viji Nair; Carine M Boustany-Kari; Paolo Guarnieri; Jon Hill; Cordell A Esplin; Matthias Kretzler; Robert G Nelson; Behzad Najafian Journal: J Am Soc Nephrol Date: 2019-06 Impact factor: 10.121
Authors: Aleksandar Denic; Marija Bogojevic; Aidan F Mullan; Moldovan Sabov; Muhammad S Asghar; Sanjeev Sethi; Maxwell L Smith; Fernando C Fervenza; Richard J Glassock; Musab S Hommos; Andrew D Rule Journal: J Am Soc Nephrol Date: 2022-08-03 Impact factor: 14.978