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The Role of Vascular Lesions in Diabetes Across a Spectrum of Clinical Kidney Disease

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review


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  • Rosa Rodríguez-Rodríguez
  • Radovan Hojs
  • Francesco Trevisani
  • Enrique Morales
  • Gema Fernández
  • Sebastjan Bevc
  • Clara María Cases Corona
  • Josep María Cruzado
  • María Quero
  • Maruja Navarro Díaz
  • Arianna Bettiga
  • Federico Di Marco
  • Marina López Martínez
  • Francisco Moreso
  • Clara García Garro
  • Khaled Khazim
  • Fedaa Ghanem
  • Manuel Praga
  • Meritxell Ibernón
  • Ivo Laranjinha
  • Luís Mendonça
  • Miguel Bigotte Vieira
  • Mads Hornum
  • Bo Feldt-Rasmussen
  • Beatriz Fernández-Fernández
  • Patricia Fox Concepción
  • Natalia Negrín Mena
  • Alberto Ortiz
  • Esteban Porrini
  • DIABESITY working group of the ERA
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Introduction: The clinical-histologic correlation in diabetic nephropathy is not completely known.

Methods: We analyzed nephrectomy specimens from 90 patients with diabetes and diverse degrees of proteinuria and glomerular filtration rate (GFR).

Results: Thirty-six (40%) subjects had normoalbuminuria, 33 (37%) microalbuminuria, and 21 (23%) non-nephrotic proteinuria. Mean estimated GFR (eGFR) was 65±23 (40% <60 ml/min per 1.73 m2). About 170 glomeruli per patient were analyzed, and all samples included vascular tissue. Six subjects (7%) were classified in diabetic nephropathy class I, 61 (68%) in class II-a, 13 (14%) in class II-b, 9 (10%) class III, and 1 (1%) in class IV. Eighty percent to 90% of those with normoalbuminuria or microalbuminuria were classified in class II-a or II-b and <10% in class III; 52% of those with proteinuria were in class II-a, 15% in class II-b, and 19% in class III. Nodular sclerosis (57%) and mesangial expansion (15%) were more frequent in cases with proteinuria than in normoalbuminuria (28% and 8%; P = 0.028 and 0.017). About 20% to 30% of all cases, regardless the level of albuminuria or proteinuria or the histologic class had tubular atrophy, interstitial fibrosis, or inflammation in >10% to 20% of the sample. Moderate hyalinosis and arteriolar sclerosis were observed in 80% to 100% of cases with normoalbuminuria, microalbuminuria, proteinuria, as well as in class I, II, or III.

Conclusions: Weak correspondence between analytical parameters and kidney histology was found. Thus, disease may progress undetected from the early clinical stages of the disease. Finally, vascular damage was a very common finding, which highlights the role of ischemic intrarenal disease in diabetes.

TidsskriftKidney International Reports
Udgave nummer9
Sider (fra-til)2392-2403
Antal sider12
StatusUdgivet - sep. 2021

Bibliografisk note

© 2021 Published by Elsevier, Inc., on behalf of the International Society of Nephrology.

ID: 70624049