Association of renal arteriosclerosis and hypertension with renal and cardiovascular outcomes in Japanese type 2 diabetes patients with diabetic nephropathy

Abstract

Aims/Introduction The present retrospective study investigated the impact of renal arteriosclerosis ( AS ) and hypertension ( HT ) on long‐term renal and cardiovascular outcomes in Japanese type 2 diabetes patients with biopsy‐proven diabetic nephropathy. Materials and Methods A total of 185 patients were enrolled. Patients were divided into four groups stratified by renal AS status and the presence of HT . The outcomes for this study were the first occurrence of renal events (a need for dialysis or a 30% decline in estimated glomerular filtration rate from baseline) and cardiovascular events (cardiovascular death, non‐fatal myocardial infarction, coronary intervention or non‐fatal stroke). Results The proportion of renal AS scores ≥1 was 88.3% among patients with normal‐range blood pressure ( BP ) and 95.4% among patients with HT. During a mean follow‐up period of 7.6 years, 129 episodes of renal composite events and 55 episodes of cardiovascular events were observed. Compared with patients with no renal AS and normal‐range BP , a renal AS score ≥1 increased the risk of renal composite events with a multivariable‐adjusted hazard ratio of 3.21 (95% confidence interval [95% CI] 1.27–8.14) in patients with normal‐range BP and 4.99 (95% CI 1.98–12.54) in patients with HT , whereas renal AS score ≥1 increased the risk of cardiovascular events with a multivariable‐adjusted hazard ratio of 6.06 (95% CI 1.24–29.61) in patients with normal‐range BP and 10.02 (95% CI 1.92–52.39) in patients with HT . Conclusions Renal AS was associated with increasing risks for renal composite events and cardiovascular events in both normal‐range BP and HT . The risks of renal composite events and cardiovascular events were the highest in both renal AS and HT .

Associations Between Continuous Glucose Monitoring-derived Metrics and Diabetic Retinopathy and Albuminuria in Patients With Type 2 Diabetes

“…Although the exact reason for these ndings is not clear, we postulated one scenario. Atherosclerosis of the intrarenal and extrarenal arteries and microangiopathy of the glomerular capillaries, afferent arterioles, and efferent arterioles are considered to contribute to the progression of glomerular lesions in DN [37,38]. Previous studies have demonstrated that glucose uctuation is more signi cantly associated with atheroscleroticrelated diseases than the degree of hyperglycemic exposure as indicated by HbA1c levels in patients with type 2 diabetes [39,40].…”

Impact of the relationship between hemoglobin levels and renal interstitial fibrosis on long-term outcomes in type 2 diabetes with biopsy-proven diabetic nephropathy

“…For light microscopic examinations, renal biopsy specimens were stained with periodic acid Schiff, periodic acid silver methenamine, hematoxylin–eosin, and Mallory–Azan. The severity of IFTA was evaluated semi-quantitatively according to the pathological classification by the Renal Pathology Society as follows: score 0, no IFTA; score 1, < 25 %; score 2, 25–50 %, and score 3, > 50 % [ 6 – 12 , 17 , 18 ]. The severity of diffuse lesion was graded from 0 to 4 by the method of Gellman et al [ 7 , 17 – 19 ].…”

“…The severity of IFTA was evaluated semi-quantitatively according to the pathological classification by the Renal Pathology Society as follows: score 0, no IFTA; score 1, < 25 %; score 2, 25–50 %, and score 3, > 50 % [ 6 – 12 , 17 , 18 ]. The severity of diffuse lesion was graded from 0 to 4 by the method of Gellman et al [ 7 , 17 – 19 ]. Nodular lesion, exudative lesion, and mesangiolysis were scored as absent or present [ 7 , 17 , 18 ].…”

“…The severity of diffuse lesion was graded from 0 to 4 by the method of Gellman et al [ 7 , 17 – 19 ]. Nodular lesion, exudative lesion, and mesangiolysis were scored as absent or present [ 7 , 17 , 18 ]. The severity of interstitial cell infiltration was graded from 0 to 2 according to the pathological classification by the Renal Pathology Society [ 6 , 7 , 17 , 18 ].…”

“…Nodular lesion, exudative lesion, and mesangiolysis were scored as absent or present [ 7 , 17 , 18 ]. The severity of interstitial cell infiltration was graded from 0 to 2 according to the pathological classification by the Renal Pathology Society [ 6 , 7 , 17 , 18 ]. The severity of arteriolar hyalinosis was graded from 0 to 3 by the method of Takazakura et al [ 7 , 17 , 18 , 20 ].…”