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

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

doi:10.1016/j.ekir.2021.06.001

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

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 LaranjinhaLuís 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

11 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Kidney International Reports
Volume	6
Issue number	9
Pages (from-to)	2392-2403
Number of pages	12
ISSN	2468-0249
DOIs	https://doi.org/10.1016/j.ekir.2021.06.001
Publication status	Published - Sept 2021

Keywords

albuminuria
chronic kidney disease
diabetes
diabetic nephropathy
histology
normoalbuminuria

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10.1016/j.ekir.2021.06.001

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Rodríguez-Rodríguez, R., Hojs, R., Trevisani, F., Morales, E., Fernández, G., Bevc, S., Cases Corona, C. M., Cruzado, J. M., Quero, M., Navarro Díaz, M., Bettiga, A., Di Marco, F., López Martínez, M., Moreso, F., García Garro, C., Khazim, K., Ghanem, F., Praga, M., Ibernón, M., ... DIABESITY working group of the ERA (2021). The Role of Vascular Lesions in Diabetes Across a Spectrum of Clinical Kidney Disease. Kidney International Reports, 6(9), 2392-2403. https://doi.org/10.1016/j.ekir.2021.06.001

Rodríguez-Rodríguez, R, Hojs, R, Trevisani, F, Morales, E, Fernández, G, Bevc, S, Cases Corona, CM, Cruzado, JM, Quero, M, Navarro Díaz, M, Bettiga, A, Di Marco, F, López Martínez, M, Moreso, F, García Garro, C, Khazim, K, Ghanem, F, Praga, M, Ibernón, M, Laranjinha, I, Mendonça, L, Bigotte Vieira, M, Hornum, M , Feldt-Rasmussen, B, Fernández-Fernández, B, Concepción, PF, Negrín Mena, N, Ortiz, A, Porrini, E & DIABESITY working group of the ERA 2021, 'The Role of Vascular Lesions in Diabetes Across a Spectrum of Clinical Kidney Disease', Kidney International Reports, vol. 6, no. 9, pp. 2392-2403. https://doi.org/10.1016/j.ekir.2021.06.001

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title = "The Role of Vascular Lesions in Diabetes Across a Spectrum of Clinical Kidney Disease",

abstract = "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.",

keywords = "albuminuria, chronic kidney disease, diabetes, diabetic nephropathy, histology, normoalbuminuria",

author = "Rosa Rodr{\'i}guez-Rodr{\'i}guez and Radovan Hojs and Francesco Trevisani and Enrique Morales and Gema Fern{\'a}ndez and Sebastjan Bevc and {Cases Corona}, {Clara Mar{\'i}a} and Cruzado, {Josep Mar{\'i}a} and Mar{\'i}a Quero and {Navarro D{\'i}az}, Maruja and Arianna Bettiga and {Di Marco}, Federico and {L{\'o}pez Mart{\'i}nez}, Marina and Francisco Moreso and {Garc{\'i}a Garro}, Clara and Khaled Khazim and Fedaa Ghanem and Manuel Praga and Meritxell Ibern{\'o}n and Ivo Laranjinha and Lu{\'i}s Mendon{\c c}a and {Bigotte Vieira}, Miguel and Mads Hornum and Bo Feldt-Rasmussen and Beatriz Fern{\'a}ndez-Fern{\'a}ndez and Concepci{\'o}n, {Patricia Fox} and {Negr{\'i}n Mena}, Natalia and Alberto Ortiz and Esteban Porrini and {DIABESITY working group of the ERA}",

note = "{\textcopyright} 2021 Published by Elsevier, Inc., on behalf of the International Society of Nephrology.",

year = "2021",

month = sep,

doi = "10.1016/j.ekir.2021.06.001",

language = "English",

volume = "6",

pages = "2392--2403",

journal = "Kidney International Reports",

issn = "2468-0249",

publisher = "Elsevier Inc.",

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TY - JOUR

T1 - The Role of Vascular Lesions in Diabetes Across a Spectrum of Clinical Kidney Disease

AU - Rodríguez-Rodríguez, Rosa

AU - Hojs, Radovan

AU - Trevisani, Francesco

AU - Morales, Enrique

AU - Fernández, Gema

AU - Bevc, Sebastjan

AU - Cases Corona, Clara María

AU - Cruzado, Josep María

AU - Quero, María

AU - Navarro Díaz, Maruja

AU - Bettiga, Arianna

AU - Di Marco, Federico

AU - López Martínez, Marina

AU - Moreso, Francisco

AU - García Garro, Clara

AU - Khazim, Khaled

AU - Ghanem, Fedaa

AU - Praga, Manuel

AU - Ibernón, Meritxell

AU - Laranjinha, Ivo

AU - Mendonça, Luís

AU - Bigotte Vieira, Miguel

AU - Hornum, Mads

AU - Feldt-Rasmussen, Bo

AU - Fernández-Fernández, Beatriz

AU - Concepción, Patricia Fox

AU - Negrín Mena, Natalia

AU - Ortiz, Alberto

AU - Porrini, Esteban

AU - DIABESITY working group of the ERA

PY - 2021/9

Y1 - 2021/9

N2 - 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.

AB - 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.

KW - albuminuria

KW - chronic kidney disease

KW - diabetes

KW - diabetic nephropathy

KW - histology

KW - normoalbuminuria

UR - http://www.scopus.com/inward/record.url?scp=85112215673&partnerID=8YFLogxK

U2 - 10.1016/j.ekir.2021.06.001

DO - 10.1016/j.ekir.2021.06.001

M3 - Journal article

C2 - 34514200

SN - 2468-0249

VL - 6

SP - 2392

EP - 2403

JO - Kidney International Reports

JF - Kidney International Reports

IS - 9

ER -

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

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