Relationship of renal size to nephropathy in Type 1 (insulin-dependent) diabetes

Ellis, Eileen N.; Steffes, Michael W.; Goetz, F. C.; Sutherland, David E.R.; Mauer, S. Michael

doi:10.1007/bf00276993

Cited by 32 publications

(14 citation statements)

References 19 publications

(36 reference statements)

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“…This agrees with the finding that the whole kidney remains enlarged with increasing duration of diabetes (15,16) and with findings in experimentally induced diabetes in rats, where glomerular hypertrophy is demonstrable after a few days (12,17) and persists after 6 mo (18) of diabetes.…”

Section: Discussionsupporting

confidence: 92%

Advanced Diabetic Glomerulopathy: Quantitative Structural Characterization of Nonoccluded Glomeruli

et al. 1987

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Quantitative ultrastructural data were obtained from kidney biopsy material of 12 long-term insulin-dependent diabetics. All patients had overt diabetic nephropathy with increased urinary albumin excretion and reduced glomerular filtration rate. Renal clearance of 51Cr-EDTA was in the range of 16-50 ml X min-1 X 1.73 m-2. All patients received antihypertensive treatment. A combined light- and electron-microscope study was performed. A significant proportion of the glomeruli was totally occluded (mean 36%, range 24-67%). Structural data presented relate only to the open, still-functioning glomeruli. Comparison with data previously obtained showed that the thickness of the peripheral basement membrane [647 nm, coefficient of variation (C.V.) 0.22] was more than twice the normal value (310 nm, C.V. 0.08); the width of epithelial foot processes (352 nm, C.V. 0.07) was significantly greater than in normal biopsies (224 nm, C.V. 0.06); and the mean volume of the open glomeruli was markedly increased compared with normal and clearly exceeded that in the early diabetic hypertrophy. Total mesangial volume and total basement membrane material per open glomerulus were increased by 277 and 614%, respectively. However, capillary length and surface per open glomerulus were similar to those observed in early diabetic hypertrophy. These findings suggest that a late glomerular hypertrophy with preservation of capillary surface occurs as a compensatory phenomenon, prolonging renal survival for diabetic nephropathy patients.

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Section: Discussionsupporting

confidence: 92%

Advanced Diabetic Glomerulopathy: Quantitative Structural Characterization of Nonoccluded Glomeruli

et al. 1987

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“…Cortical and medullary volumes in the microalbuminuric patients were also similar, in spite of likely underlying marked glomerular and medullary structural changes. This finding is supported by previous observations of normal total renal volume in advanced diabetic kidney disease, in contrast to reduced volume in other chronic kidney diseases [3].…”

Section: Discussionsupporting

confidence: 90%

“…Unlike in other chronic kidney diseases, kidney size remains normal or even increased in diabetic nephropathy [3]. Expansion of both cortex and medulla occurs in animal models of diabetes [4], but there are no such data in type 1 diabetes, and it is not known whether the ratio of cortex to medulla alters as the disease progresses.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive investigation of kidney disease in type 1 diabetes by magnetic resonance imaging

2011

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“…At diagnosis and within the first 12 years of onset, renal hypertrophy correlates with increased GFR (36,41,42). Mauer et al (43) addressed the relationship during the second decade of diabetes in 35 subjects (mean IDDM duration 18 years), including 13 with overt nephropathy. Kidney size (measured as renal area index) correlated with creatinine clearance but not with disease duration, urinary albumin excretion, or percentage mesangial volume.…”

Section: Discussionmentioning

confidence: 98%

Effect of Puberty on Markers of Glomerular Hypertrophy and Hypertension in IDDM

Lawson

Sochett²,

Chait³

et al. 1996

Diabetes

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Epidemiological data implicate puberty as a factor in the initiation of diabetic nephropathy. However, the mechanism remains unclear. We hypothesized that puberty would result in an increase in glomerular hypertrophy and hypertension; these two early concomitant events are seen as pivotal to the pathophysiology of diabetic nephropathy. We studied the effect of pubertal duration on three surrogate markers of glomerular hypertrophy/hypertension: kidney volume (KV), microalbuminuria (MA), and Na-Li countertransport (CT). We recruited 177 subjects (87 female and 90 male; aged 6.2-22.1 years) with IDDM of 5 to 10 years' duration (6.8 +/- 1.6 years) into three groups with different pubertal duration: prepubertal since IDDM diagnosis; prepubertal at diagnosis, now pubertal; or early puberty at diagnosis, now postpubertal. KV was measured by ultrasound and corrected for body surface area; MA was defined as urinary albumin excretion of 15-200 micrograms/min in two of three 24-h samples, and Na-Li CT was measured in erythrocytes. As pubertal duration increased, there was a disproportionate increase in mean KV (prepubertal, 247 +/- 6 [SE] ml/1.73 m2; pubertal, 282 +/- 7/1.73 m2; postpubertal, 295 +/- 7/1.73 m2, P = 0.001), prevalence of nephromegaly (KV > 300 ml/1.73 m2) (14, 31, and 45%, respectively, P = 0.001), and prevalence of MA (0, 9.7, and 20.5%, respectively, P = 0.003). Subjects with KV > 300 ml/1.73 m2 were eight times more likely to have MA than those with KV < 300 (odds ratio 8.1, 95% confidence interval 2.4-27.4, P = 0.0001). There was no effect of pubertal duration on Na-Li CT. Multiple regression with KV as the dependent variable found an association with pubertal duration, MA, Na-Li CT, and current HbA1c (P < 0.0001). Our findings indicate that pubertal duration is an important determinant of both KV and MA and suggest that nephromegaly precedes microalbuminuria. We postulate that these effects are attributable to the influence of the pubertal milieu on glomerular hypertrophy/hypertension.

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Relationship of renal size to nephropathy in Type 1 (insulin-dependent) diabetes

Cited by 32 publications

References 19 publications

Advanced Diabetic Glomerulopathy: Quantitative Structural Characterization of Nonoccluded Glomeruli

Advanced Diabetic Glomerulopathy: Quantitative Structural Characterization of Nonoccluded Glomeruli

Non-invasive investigation of kidney disease in type 1 diabetes by magnetic resonance imaging

Effect of Puberty on Markers of Glomerular Hypertrophy and Hypertension in IDDM

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