Impact of tubulointerstitial lesions on anaemia in patients with biopsy‐proven diabetic nephropathy

Abstract

AimsTo investigate the relationship between the progression of anaemia and renal pathological findings in patients with diabetic nephropathy.MethodsA total of 223 patients with diabetes underwent renal biopsy from 1985 to 2010 and were confirmed to have pure diabetic nephropathy according to the recent classification, of whom 113 (baseline haemoglobin ≥ 11 g/dl) were enrolled in the study. Linear regression analysis was used to estimate the changes in haemoglobin levels during the follow-up period.ResultsIn a multivariate model adjusted for clinical and histopathological variables, higher interstitial fibrosis and tubular atrophy scores were more strongly associated with a decrease in haemoglobin levels than were lower scores. Compared with an interstitial fibrosis and tubular atrophy score of 0, the standardized coefficients for interstitial fibrosis and tubular atrophy scores of 1, 2 and 3 were 0.20 (95% CI −0.31 to 0.93), 0.34 (95% CI −0.22 to 1.34) and 0.47 (95% CI 0.07 to 1.96), respectively, whereas a higher glomerular class, a higher vascular lesion score and the presence of exudative lesions were not strongly correlated with the decrease in haemoglobin.ConclusionsTubulointerstitial lesions that are more advanced are significantly associated with the progression of anaemia in patients with diabetic nephropathy after adjustment for numerous covariates. This finding suggests that tubulointerstitial lesions may be a useful prognostic indicator for anaemia in patients with diabetic nephropathy, and that decreased erythropoietin production attributable to the progression of tubulointerstitial lesions is a major cause of anaemia in these patients.

Reproducibility of the NEPTUNE descriptor-based scoring system on whole-slide images and histologic and ultrastructural digital images

“…To test concordance of non-glomerular parameters, we considered the most clinically relevant tubulointer-stitial parameters, 17–22 the percentage (0–100%) of cortex involved by interstitial fibrosis and tubular atrophy, for 244 cases. Conventional pathology practice includes semiquantitative assessment of interstitial fibrosis and tubular atrophy.…”

Clinical and pathological predictors of estimated GFR decline in patients with type 2 diabetes and overt proteinuric diabetic nephropathy

“…HbA 1c is presented as the National Glycohemoglobin Standardization Program values according to the recommendations of the Japanese Diabetes Society and International Federation of Clinical Chemistry . Hematuria was defined as in our previous study, and the average annual values of clinical parameters such as UP, systolic and diastolic blood pressure (BP) and HbA 1c were calculated during follow‐up . Treatment with an angiotensin‐converting enzyme inhibitors (ACE‐I) or angiotensin II type I receptor blockers (ARB) was defined as administration for more than half of the follow‐up period.…”

Prognostic Value of Tubulointerstitial Lesions, Urinary N-Acetyl-β-D-Glucosaminidase, and Urinary β2-Microglobulin in Patients with Type 2 Diabetes and Biopsy–Proven Diabetic Nephropathy

“…GFR was estimated by using the Japanese coefficient-modified Chronic Kidney Disease Epidemiology Collaboration Equation (17), whereas baseline UP was measured in a 24-hour urine specimen. In this study, the presences of normoalbuminuria, microalbuminuria, and macroalbuminuria were defined as urinary albumin excretion (UAE) ,30 mg/g creatinine, UAE$30 and ,300 mg/g creatinine, and UAE.300 mg/g creatinine, respectively, in at least two of three consecutive urine specimens obtained immediately before and after renal biopsy (18) (13,20). If data for any of these variables were unavailable during follow-up, the mean value of the observations before and after the missing value was calculated and used instead.…”