Kengo Furuichi1, Miho Shimizu1, Yukio Yuzawa2, Akinori Hara1, Tadashi Toyama1, Hiroshi Kitamura3, Yoshiki Suzuki4, Hiroshi Sato5, Noriko Uesugi6, Yoshifumi Ubara7, Junichi Hohino7, Satoshi Hisano8, Yoshihiko Ueda9, Shinichi Nishi10, Hitoshi Yokoyama11, Tomoya Nishino12, Kentaro Kohagura13, Daisuke Ogawa14, Koki Mise14, Yugo Shibagaki15, Hirofumi Makino14, Seiichi Matsuo16, Takashi Wada17. 1. Department of Nephrology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan. 2. Department of Nephrology, Fujita Health University Hospital, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. 3. Department of Pathology, Clinical Research Center, National Hospital Organization Chiba East National Hospital, 673 Nitona, Chiba, Chiba, 260-8712, Japan. 4. Health Administration Center, Niigata University, 2-8085, Igarashi, Nishi-ku, Niigata, Niigata, 950-2181, Japan. 5. Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences, 6-3 Aoba, Aramaki, Aoba-ku, Sendai, 980-8578, Japan. 6. Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. 7. Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato, Tokyo, 105-8470, Japan. 8. Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 9. Department of Pathology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan. 10. Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. 11. Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan. 12. Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. 13. Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus School of Medicine, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan. 14. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan. 15. Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan. 16. Division of Nephrology, Department of Internal Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. 17. Department of Nephrology and Laboratory Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan. twada@m-kanazawa.jp.
Abstract
BACKGROUND: The Japanese classification of diabetic nephropathy reflects the risks of mortality, cardiovascular events and kidney prognosis and is clinically useful. Furthermore, pathological findings of diabetic nephropathy are useful for predicting prognoses. In this study, we evaluated the characteristics of pathological findings in relation to the Japanese classification of diabetic nephropathy and their ability to predict prognosis. METHODS: The clinical data of 600 biopsy-confirmed diabetic nephropathy patients were collected retrospectively from 13 centers across Japan. Composite kidney events, kidney death, cardiovascular events, all-cause mortality, and decreasing rate of estimated GFR (eGFR) were evaluated based on the Japanese classification of diabetic nephropathy. RESULTS: The median observation period was 70.4 (IQR 20.9-101.0) months. Each stage had specific characteristic pathological findings. Diffuse lesions, interstitial fibrosis and/or tubular atrophy (IFTA), interstitial cell infiltration, arteriolar hyalinosis, and intimal thickening were detected in more than half the cases, even in Stage 1. An analysis of the impacts on outcomes in all data showed that hazard ratios of diffuse lesions, widening of the subendothelial space, exudative lesions, mesangiolysis, IFTA, and interstitial cell infiltration were 2.7, 2.8, 2.7, 2.6, 3.5, and 3.7, respectively. Median declining speed of eGFR in all cases was 5.61 mL/min/1.73 m2/year, and the median rate of declining kidney function within 2 years after kidney biopsy was 24.0%. CONCLUSIONS: This study indicated that pathological findings could categorize the high-risk group as well as the Japanese classification of diabetic nephropathy. Further study using biopsy specimens is required to clarify the pathogenesis of diabetic kidney disease.
BACKGROUND: The Japanese classification of diabetic nephropathy reflects the risks of mortality, cardiovascular events and kidney prognosis and is clinically useful. Furthermore, pathological findings of diabetic nephropathy are useful for predicting prognoses. In this study, we evaluated the characteristics of pathological findings in relation to the Japanese classification of diabetic nephropathy and their ability to predict prognosis. METHODS: The clinical data of 600 biopsy-confirmed diabetic nephropathypatients were collected retrospectively from 13 centers across Japan. Composite kidney events, kidney death, cardiovascular events, all-cause mortality, and decreasing rate of estimated GFR (eGFR) were evaluated based on the Japanese classification of diabetic nephropathy. RESULTS: The median observation period was 70.4 (IQR 20.9-101.0) months. Each stage had specific characteristic pathological findings. Diffuse lesions, interstitial fibrosis and/or tubular atrophy (IFTA), interstitial cell infiltration, arteriolar hyalinosis, and intimal thickening were detected in more than half the cases, even in Stage 1. An analysis of the impacts on outcomes in all data showed that hazard ratios of diffuse lesions, widening of the subendothelial space, exudative lesions, mesangiolysis, IFTA, and interstitial cell infiltration were 2.7, 2.8, 2.7, 2.6, 3.5, and 3.7, respectively. Median declining speed of eGFR in all cases was 5.61 mL/min/1.73 m2/year, and the median rate of declining kidney function within 2 years after kidney biopsy was 24.0%. CONCLUSIONS: This study indicated that pathological findings could categorize the high-risk group as well as the Japanese classification of diabetic nephropathy. Further study using biopsy specimens is required to clarify the pathogenesis of diabetic kidney disease.
Entities:
Keywords:
Exudative lesions; Japanese classification of diabetic nephropathy; Kidney biopsy; Mesangiolysis; Nodular lesions; Widening of the subendothelial space
Authors: Y Suzuki; M Ueno; H Hayashi; S Nishi; H Satou; R Karasawa; H Inn; S Suzuki; Y Maruyama; M Arakawa Journal: Clin Nephrol Date: 1994-09 Impact factor: 0.975
Authors: K Mise; J Hoshino; T Ueno; A Imafuku; M Kawada; K Sumida; R Hiramatsu; E Hasegawa; M Yamanouchi; N Hayami; T Suwabe; N Sawa; T Fujii; S Hara; K Ohashi; K Takaichi; Y Ubara Journal: Diabet Med Date: 2014-12-16 Impact factor: 4.359