Nephrol Dial Transplant (2000) 15: 1609-1616
© 2000 European Renal Association-European Dialysis and Transplant Association
Follow-up study of glomerular dimensions and cortical interstitium in microalbuminuric type 1 diabetic patients with or without antihypertensive treatment
1 Electron Microscopy Laboratory, Institute of Experimental Clinical Research and Institute of Pathology, Aarhus University, Denmark, 2 Pediatric Department, Ullevål University Hospital, Oslo, Norway, and 3 Department of Woman and Child Health, Pediatric Unit, Karolinska Institute, Stockholm, Sweden
Background. A decrease in urinary albumin excretion is regularly seen with antihypertensive treatment in patients with diabetic nephropathy. Our study concerns structural data obtained by light microscopy in baseline and follow-up biopsies in antihypertensive treated patients and in a reference group.
Methods. Microalbuminuric type 1 diabetic patients with diabetes duration of 6–16 years were studied. Two groups, allocated to treatment with either angiotensin-converting enzyme-inhibitor (group 1, n=6) or ß-blocker (group 2, n=6) after the baseline biopsy, were studied in parallel, whereas the reference group (group 3, n=9), without antihypertensive treatment, was part of a previously completed study. The renal plastic-embedded biopsies were serially sectioned (1 µm), the sections being used for determining glomerular volume, vascular pole area, and interstitial space expressed as fraction of tubular cortex.
Results. A significant increase in glomerular volume (P=0.04) was seen in group 3 only. Vascular pole area (VPA) and VPA relative to calculated glomerular surface did not show significant changes in any of the groups, only a tendency to increase in VPA in group 3 (P=0.051). The increase in VPA correlated with systolic blood pressure during the study period (r=0.49, P=0.03). Glomerular volume did not correlate with HbA1C, current diabetic glomerulopathy, or ensuing worsening of glomerulopathy. In group 3 every case showed an increase in interstitium (P=0.0009), group 2 showed a decrease (P=0.03), and group 1 showed no change. Increase in interstitial fractional volume correlated with diastolic blood pressure during the study (r=0.54, P=0.01).
Conclusions. In early microalbuminuria, type 1 diabetic patients show glomerular growth, probably compensatory to the developing glomerulopathy. The increase in interstitial volume fraction, demonstrable in early nephropathy, is further augmented over a few years, but is arrested by antihypertensive treatment.
Keywords: antihypertensive treatment; diabetic glomerulopathy; glomerular size; glomerular vascular pole; microalbuminuria; renal interstitium
Correspondence and offprint requests to: Ruth Østerby, Electron Microscopy Laboratory, Building 03, Aarhus Kommunehospital, DK-8000 Aarhus C, Denmark.
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