Renal prognosis a long time after renal biopsy on patients with diabetic nephropathy

Abstract

BackgroundA new classification of diabetic nephropathy was reported by Tervaert et al., but the association between pathological findings and the clinical outcomes remains unclear.MethodsAmong 310 patients with diabetes mellitus who underwent renal biopsy from March 1985 to January 2010 and were confirmed to have diabetic nephropathy according to the Tervaert's classification, 205 patients were enrolled in this study. Cox proportional hazard regression analysis was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for death-censored renal death. Each regression analysis employed two levels of multivariate adjustment.ResultsAfter adjustment for age, gender, estimated glomerular filtration rate, type of diabetes, urinary protein excretion, systolic blood pressure, body mass index, HbA1c, diabetic retinopathy and red blood cells in urinary sediment at the time of renal biopsy, compared with glomerular class IIA, the HRs for death-censored renal death of glomerular classes I, IIB, III and IV were 0.21 (95% CI: 0.04–1.25), 2.12 (0.89–5.04), 4.23 (1.80–9.90), and 3.27 (1.32–8.10), respectively. Also, compared with an interstitial fibrosis and tubular atrophy score 1 group, HRs for score 0 group, score 2 group and score 3 group were 0.08 (0.01–0.57), 2.17 (0.96–4.91), 4.78 (1.96–11.68), respectively.ConclusionsThe progression of glomerular, tubulointerstitial and vascular lesions was associated with higher HRs for renal death. These results suggest the clinical utility of Tervaert's pathological classification.

Serum Autotaxin Levels Are Associated with Proteinuria and Kidney Lesions in Japanese Type 2 Diabetic Patients with Biopsy-proven Diabetic Nephropathy

“…Our previous report which investigated 260 type 2 diabetic patients with biopsy-proven diabetic nephropathy showed that diabetic glomerular lesions, IFTA, and arteriosclerosis were the pathological determinants for renal composite events (3). Several other reports have found that diabetic kidney lesions were associated with the renal outcome, and such findings are in line with our results (49,50). Based on these results, it is reasonable to predict the renal outcome of diabetic nephropathy by combination of clinical and pathological parameters.…”

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.…”

“…Specimens for light microscopy were stained with hematoxylin and eosin, periodic acid-Schiff, Weigert elastica-van Gieson, Masson trichrome, or periodic acid methenamine silver stain according to routine methods. Classification of DN and determination of histologic scores (including exudative lesions) according to the criteria of the RPS and the criteria used in our previous study (13,16) were done by at least two renal pathologists and/or nephrologists who were unaware of the clinical status of each patient.…”

“…We recently reported that the extent of interstitial fibrosis and tubular atrophy (IFTA) was a significant predictor of the renal prognosis, even after adjustment for urinary protein excretion (UP) (12,13). There have also been some other recent reports that stressed the influence of IFTA on the renal prognosis (14,15).…”

“…At our institution, a relatively large number of patients with diabetes have had DN confirmed by renal biopsy and have also been followed up for a long period (13). In most of them, urinary NAG and b2-MG were examined at the time of renal biopsy as markers of tubulointerstitial injury.…”