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NDT Advance Access originally published online on June 16, 2008
Nephrology Dialysis Transplantation 2008 23(11):3539-3545; doi:10.1093/ndt/gfn351
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Prevalence of atubular glomeruli in type 2 diabetic patients with nephropathy

Kathryn E. White1, Sally M. Marshall1 and Rudolf W. Bilous2

1 School of Clinical Medical Sciences, Newcastle University, Newcastle upon Tyne 2 James Cook University Hospital, Middlesbrough, UK

Correspondence and offprint requests to: Kathryn E. White, EM Research Services, Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. Tel/Fax: +44-191-2226966; E-mail: k.e.white{at}ncl.ac.uk



  Abstract

Background. Atubular glomeruli have been identified in a number of chronic renal diseases and have been linked to declining renal function. In type 1 diabetes they are present predominantly in proteinuric patients. We investigated the prevalence of atubular glomeruli in type 2 diabetes and their relationship to renal function.

Methods. Renal biopsies from 12 type 2 diabetic patients with nephropathy were processed for light and electron microscopy and analysed using standard stereological techniques. Abnormalities at the glomerular tubular junction were quantified using an index of junctional atrophy (IJA).

Results. There was no relationship between the degree of proteinuria and the presence of atubular glomeruli or atrophic tubules. Creatinine clearance correlated with the IJA (r = –0.70, P = 0.011), percent sclerosed glomeruli (r = –0.59, P = 0.027) and interstitial volume fraction (r = –0.54, P = 0.037). The IJA also correlated with foot process width and volume fraction interstitium (r = 0.58, P = 0.049 for both). Percent sclerosed glomeruli correlated with mesangial (r = 0.65, P = 0.012) and interstitial (r = 0.69, P = 0.007) volume fractions.

Conclusions. In contrast to type 1 diabetes, atubular glomeruli and atrophic tubules occur in type 2 diabetic patients with low levels of proteinuria; their development may influence the progressive change in GFR. Both glomerular and interstitial damage may lead to the development of atubular glomeruli in type 2 diabetic nephropathy.

Keywords: diabetic glomerulopathy; glomerular filtration rate; morphology; proteinuria

Received for publication: 5. 2.08
Accepted in revised form: 29. 5.08


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