Nephrology Dialysis Transplantation, Vol 14, Issue 2 348-352, Copyright © 1999 by Oxford University Press
R Osterby, J Asplund, H Bangstad, G Nyberg, S Rudberg, G Viberti and J Walkert
Background: Diabetic nephropathy is associated with
renal structural changes involving all of the compartments. Most
characteristic is the diabetic glomerulopathy. Studies of the histological
changes during the early phases of nephropathy have included the
glomerulopathy and also the juxtaglomerular structures. Neovascularization,
well-known in diabetic retinopathy, has also been observed in the kidney.
The present study concerns estimates of frequency of neovascularization at
the vascular pole region in early stages of diabetic nephropathy.
Methods: Extra efferent arterioles at the glomerular
vascular pole were detected during measurements of the vascular pole area
applying 1-&mgr;m serial sections through kidney biopsies. It was
observed that more than one efferent arteriole existed occasionally. The
present study was carried out with the aim of estimating the frequency of
this phenomenon in diabetic patients and in non-diabetic controls, the
diabetic patients categorized according to the level of albumin excretion.
Results: Neovascularization was first observed in IDDM
patients with microalbuminuria. Some of the cases presented the phenomenon
in all of the glomeruli studied. As the examinations of many kidney
biopsies continued the phenomenon was observed also in the non-diabetic
control group and in one IDDM patient with normoalbuminuria. However, the
frequency was statistically highly significantly increased in patients with
elevated albumin excretion. Within this group a strong correlation between
frequency of neovascularization and the severity of diabetic glomerulopathy
is seen. Conclusions: The vascular abnormality
localized to the vascular pole region is observed occasionally in the
normal kidney, but the frequency is increased in patients with diabetic
glomerulopathy. The abnormality may develop as a consequence of a
longstanding diabetic glomerulopathy and might lead to less pronounced
elevation of albumin excretion. Key words: diabetic
glomerulopathy; glomerular vascular pole; juxtaglomerular arterioles;
microalbuminuria; neovascularization
ORIGINAL ARTICLES
Neovasularization at the vascular pole region in diabetic glomerulopathy
Electron Microscopy Laboratory, Building 03, Aarhus Kommunehospital, DK-8000 Aarhus C, Denmark; Department of Internal medicine, Falu County Hospital, Falun, Sweden; Aker Diabetes Research Centre, Oslo, Norway; Transplant Unit, Sahlgrenska University Hospital, Gotebrog, Sweden; Department of Woman and Child Health, Pediatric Unit Karolinska Institute, Stockholm, Sweden; Unit for Metabolic Medicine, Guy's Hospital, London, UK; Corresponding author
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