1. The role of vascular lesions in diabetes across a spectrum of clinical kidney diseaseRosa Rodriguez-Rodriguez, Radovan Hojs, Francesco Trevisani, Enrique Morales, Gema Fernández, Sebastjan Bevc, Clara Maria Cases Corona, Josep Maria Cruzado, María Quaro, Maruja Navarro Díaz, Mads Hornum, Beatriz Fernandez-Fernandez, Arianna Bettiga, Federico Di Marco, Marina López Martínez, Francisco J. Moreso, Clara García Garro, Khaled Khazim, Fedaa Ghanem, Manuel Praga, Meritxell Ibernón, Ivo Laranjinha, Luís Mendonça, Miguel Bigotte Vieira, Bo Feldt-Rasmussen, Patricia Fox Concepción, Natalia Negrín Mena, Alberto Ortiz, Esteban L. Porrini, 2021, original scientific article 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
Published in DKUM: 06.12.2024; Views: 0; Downloads: 10
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