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Study at AMED Collecting 600 Biopsy-Proven Diabetic Nephropathies

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Diabetic Kidney Disease

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Abstract

Diabetic nephropathy (DN) is a major cause of end-stage kidney failure after exacerbation of proteinuria. Pathological changes in the kidneys in diabetic patients, such as diffuse lesions, nodular lesion, mesangiolysis, peri-hilar neovascularization (polar vasculosis), and arteriolar hyalinosis, are detected in advanced cases. However, recent study revealed that the onset and progression pattern of kidney dysfunction and proteinuria greatly vary with each case. Therefore, with support from the Ministry of Health, Labour and Welfare in Japan and the Japan Agency for Medical Research and Development (AMED), 600 kidney biopsies from diabetic cases were collected from 13 facilities throughout Japan and analyzed. Nine glomerular lesions and four interstitial and vascular lesions were evaluated.

The scores of each pathological finding correlated strongly with that of other pathological findings. Moreover, even in stage 1 of the classification of diabetic nephropathy in Japan, more than half of the cases exhibited diffuse lesions, interstitial fibrosis and tubular atrophy (IFTA), interstitial cell infiltration, arteriolar hyalinosis, and intimal thickening. In stage 2, more than half of the cases had polar vasculosis. In stage 3, approximately half of the cases had subendothelial space widening, exudative lesions, nodular lesions, and mesangiolysis.

Pathological findings have characteristic impacts on clinical outcomes. In the analysis of all 600 cases, all 13 types of pathological findings predict the occurrence of composite kidney events (dialysis, halving of eGFR, or doubling of serum Cr). After adjustments for age and gender, each pathological finding showed characteristic hazard ratios (HRs) for the composite kidney events in each clinical stage. Nodular lesions and mesangiolysis had high HRs in stages 1 and 2. Exudative lesions had a high HR in stage 1, and subendothelial space widening had a high HR in stages 2 and 4. In stage 3, IFTA and interstitial cell infiltration had high HRs.

In conclusion, pathological findings classified the risk of kidney dysfunction in addition to the Japanese clinical classification of DN.

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Authors and Affiliations

  1. Department of Nephrology, Kanazawa Medical University, Uchinada, Japan

    Kengo Furuichi

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  1. Kengo Furuichi
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Correspondence to Kengo Furuichi .

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Editors and Affiliations

  1. Department of Nephrology and Laboratory, Kanazawa University, Kanazawa, Ishikawa, Japan

    Takashi Wada

  2. Department of Nephrology, Kanazawa Medical University, Kanazawa, Ishikawa, Japan

    Kengo Furuichi

  3. Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Okayama, Japan

    Naoki Kashihara

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Furuichi, K. (2021). Study at AMED Collecting 600 Biopsy-Proven Diabetic Nephropathies. In: Wada, T., Furuichi, K., Kashihara, N. (eds) Diabetic Kidney Disease. Springer, Singapore. https://doi.org/10.1007/978-981-15-9301-7_9

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  • DOI: https://doi.org/10.1007/978-981-15-9301-7_9

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-9300-0

  • Online ISBN: 978-981-15-9301-7

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