Nephrol Dial Transplant (2001) 16: 2337-2347
© 2001 European Renal Association-European Dialysis and Transplant Association
Renal function and structure in albuminuric type 2 diabetic patients without retinopathy
1 Steno Diabetes Center, Gentofte and 2 Department of Pathology, Herlev Hospital, Herlev, Denmark
Background. In type 2 diabetic patients without retinopathy the cause of albuminuria is heterogeneous and our knowledge of the relationship between kidney structure and function in these patients is limited. Therefore, a long-term study evaluating the structural–functional relationship in albuminuric type 2 diabetic patients without retinopathy was performed.
Methods. Mesangial volume of total glomerular volume (Vv (mes/glom)), fractional area of focal interstitial fibrosis and tubular atrophy of cortical area (FF) and percentage of sclerosed glomeruli (S/G) were measured on kidney biopsies from 49 type 2 diabetic patients without retinopathy. Glomerular filtration rate (GFR) was determined at least 3 times (median 8 (range 3–20)) in each patient. Patients were followed for 7.0 (1.1–17) years. Albuminuria and blood pressure were measured every 3–6 months.
Results. Biopsies revealed diabetic glomerulopathy (DG-group) in 69% of the patients (27 male/7 female) and normal glomerular structure (n=9) or glomerulonephritis (n=6) were found in 31% (13 male/2 female) (NDG-group). In the DG-group GFR decreased from 97±5 to 66±5 ml/min/1.73 m2 (mean±SE) (P<0.001), with a rate of decline in GFR of 5.3±0.8 ml/min/year and in the NDG-group from 93±7 to 74±11 ml/min/1.73 m2 (P<0.01), with a rate of decline in GFR of 3.2±0.9 ml/min/year, P=0.09 between groups. Mean arterial blood pressure decreased from 109±2 to 100±2 mm Hg (P<0.001) (DG-group) and remained unchanged in the NDG-group. An association between Vv (mes/glom) and rate of decline in GFR was revealed mainly in the NDG-group (DG-group; r=0.31, P=0.07 and NDG-group; r=0.74, P<0.01). Furthermore, the rate of decline in GFR seemed to be associated with FF in the NDG group (r=0.48, P=0.07). Percentage of S/G was not associated with the rate of decline in GFR. Vv (mes/glom) was associated with mean albuminuria during follow-up in the DG group; r=0.38, P<0.03 (NDG group; r=0.51, P=0.09). Albuminuria was an independent predictor of the rate of decline in GFR in both groups (DG-group; r=0.40, P<0.05 and NDG-group; r=0.61, P<0.01).
Conclusions. Our study revealed a tendency to a faster rate of decline in GFR in the DG-group compared to the much smaller NDG-group, characterized by marked heterogeneity of the underlying kidney lesions and rate of GFR loss. A large mesangial volume fraction was associated with increased albuminuria and loss in GFR. Albuminuria acted as a progression promoter in both groups.
Keywords: albuminuria; diabetic glomerulopathy; glomerular filtration rate; hypertension; mesangium; non-diabetic glomerulopathies; retinopathy; type 2 diabetes mellitus
Correspondence and offprint requests to: Per K. Christensen, Steno Diabetes Center, Niels Steensens Vej 2, DK-2820 Gentofte, Denmark. Email: pkc{at}novonordisk.com
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