Abstract
Details of renal structural changes and structural-functional relationships at the early stage of diabetic nephropathy in both types 1 and 2 diabetes are not well known. The present review focused on these topics from previous studies using light and electron microscopic morphometric analysis. Typical glomerular histological changes, glomerular basement membrane thickening, and mesangial expansion are already present in normoalbuminuric types 1 and 2 diabetic patients as a group. However, these parameters are similar between normo- and microalbuminuric type 2 diabetic patients, and therefore, relationships between renal structure and urinary albumin excretion cannot be seen in type 2 diabetic patients, and urinary albumin might not be an early reliable indicator for glomerular structural changes in type 2 diabetic patients. These phenomena might be due to histological heterogeneity in type 2 diabetic patients, which is not seen in type 1 diabetic patients. However, type 2 diabetic patients with typical diabetic glomerulosclerosis showed significant renal functional decline after 11 years observation. On the other hand, it is unclear whether lesions of diabetic nephropathy are concordant or discordant with diabetic retinopathy grade in type 2 diabetes. From above information, renal structural changes or structural-functional relationships in type 2 diabetic patients might be heterogeneous and different from those in type 1 diabetic patients. Careful longitudinal study of renal structure and function including serial renal biopsy at the early stage of diabetic nephropathy in patients with types 1 and 2 diabetes is necessary.
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References
Caramori ML, Fioretto P, Mauer M. Low glomerular filtration rate in normoalbuminuric type 1 diabetic patients: an indicator of more advanced glomerular lesions. Diabetes. 2003;52(4):1036–40.
Ekinci EI, Jerums G, Skene A, et al. Renal structure in normoalbuminuric and albuminuric patients with type 2 diabetes and impaired renal function. Diabetes Care. 2013;36(11):3620–6.
Mauer SM, Steffes MW, Ellis EN, Sutherland DE, Brown DM, Goetz FC. Structural-functional relationships in diabetic nephropathy. J Clin Invest. 1984;74(4):1143–55.
Lane PH, Steffes MW, Fioretto P, Mauer SM. Renal interstitial expansion in insulin-dependent diabetes mellitus. Kidney Int. 1993;43(3):661–7.
Jensen EB, Gundersen HJ, Osterby R. Determination of membrane thickness distribution from orthogonal intercepts. J Microsc. 1979;115(1):19–33.
Fioretto P, Steffes MW, Mauer M. Glomerular structure in nonproteinuric IDDM patients with various levels of albuminuria. Diabetes. 1994;43(11):1358–64.
Weibel ER. Morphometry of the human lung: the state of the art after two decades. Bull Eur Physiopathol Respir. 1979;15(5):999–1013.
Harris RD, Steffes MW, Bilous RW, Sutherland DE, Mauer SM. Global glomerular sclerosis and glomerular arteriolar hyalinosis in insulin dependent diabetes. Kidney Int. 1991;40(1):107–14.
Drummond K, Mauer M, International Diabetic Nephropathy Study Group. The early natural history of nephropathy in type 1 diabetes: II. Early renal structural changes in type 1 diabetes. Diabetes. 2002;51(5):1580–7.
Moriya T, Omura K, Matsubara M, Yoshida Y, Hayama K, Ouchi M. Arteriolar hyalinosis predicts increase in albuminuria and GFR decline in normo- and microalbuminuric japanese patients with type 2 diabetes. Diabetes Care. 2017;40(10):1373–8.
Fioretto P, Mauer M, Brocco E, et al. Patterns of renal injury in NIDDM patients with microalbuminuria. Diabetologia. 1996;39(12):1569–76.
Moriya T, Moriya R, Yajima Y, Steffes MW, Mauer M. Urinary albumin as an indicator of diabetic nephropathy lesions in Japanese type 2 diabetic patients. Nephron. 2002;91(2):292–9.
Fioretto P, Steffes MW, Sutherland DE, Mauer M. Sequential renal biopsies in insulin-dependent diabetic patients: structural factors associated with clinical progression. Kidney Int. 1995;48(6):1929–35.
Caramori ML, Parks A, Mauer M. Renal lesions predict progression of diabetic nephropathy in type 1 diabetes. J Am Soc Nephrol. 2013;24(7):1175–81.
Ellis EN, Steffes MW, Goetz FC, Sutherland DE, Mauer SM. Glomerular filtration surface in type I diabetes mellitus. Kidney Int. 1986;29(4):889–94.
Moriya T, Tsuchiya A, Okizaki S, Hayashi A, Tanaka K, Shichiri M. Glomerular hyperfiltration and increased glomerular filtration surface are associated with renal function decline in normo- and microalbuminuric type 2 diabetes. Kidney Int. 2012;81(5):486–93.
Caramori ML, Kim Y, Huang C, et al. Cellular basis of diabetic nephropathy: 1. Study design and renal structural-functional relationships in patients with long-standing type 1 diabetes. Diabetes. 2002;51(2):506–13.
Moriya T, Tanaka K, Hosaka T, Hirasawa Y, Fujita Y. Renal structure as an indicator for development of albuminuria in normo- and microalbuminuric type 2 diabetic patients. Diabetes Res Clin Pract. 2008;82(3):298–304.
Nosadini R, Velussi M, Brocco E, et al. Course of renal function in type 2 diabetic patients with abnormalities of albumin excretion rate. Diabetes. 2000;49(3):476–84.
Fufaa GD, Weil EJ, Lemley KV, et al. Structural predictors of loss of renal function in American Indians with type 2 diabetes. Clin J Am Soc Nephrol. 2016;11(2):254–61.
Mise K, Hoshino J, Ueno T, et al. Prognostic value of tubulointerstitial lesions, urinary N-acetyl-beta-d-glucosaminidase, and urinary beta2-microglobulin in patients with type 2 diabetes and biopsy-proven diabetic nephropathy. Clin J Am Soc Nephrol. 2016;11(4):593–601.
Shimizu M, Furuichi K, Toyama T, et al. Long-term outcomes of Japanese type 2 diabetic patients with biopsy-proven diabetic nephropathy. Diabetes Care. 2013;36(11):3655–62.
Li L, Zhang X, Li Z, et al. Renal pathological implications in type 2 diabetes mellitus patients with renal involvement. J Diabetes Complicat. 2016;31(1):114–21.
Moriya T, Suzuki Y, Inomata S, Iwano M, Kanauchi M, Haneda M. Renal histological heterogeneity and functional progress in normoalbuminuric and microalbuminuric Japanese patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2014;2(1):e000029.
Myers BD, Nelson RG, Williams GW, et al. Glomerular function in Pima Indians with noninsulin-dependent diabetes mellitus of recent onset. J Clin Invest. 1991;88(2):524–30.
Li L, Zhang X, Li Z, et al. Renal pathological implications in type 2 diabetes mellitus patients with renal involvement. J Diabetes Complicat. 2017;31(1):114–21.
Bangstad HJ, Osterby R, Dahl-Jorgensen K, Berg KJ, Hartmann A, Hanssen KF. Improvement of blood glucose control in IDDM patients retards the progression of morphological changes in early diabetic nephropathy. Diabetologia. 1994;37(5):483–90.
Bangstad HJ, Osterby R, Rudberg S, Hartmann A, Brabrand K, Hanssen KF. Kidney function and glomerulopathy over 8 years in young patients with Type I (insulin-dependent) diabetes mellitus and microalbuminuria. Diabetologia. 2002;45(2):253–61.
Taft JL, Nolan CJ, Yeung SP, Hewitson TD, Martin FI. Clinical and histological correlations of decline in renal function in diabetic patients with proteinuria. Diabetes. 1994;43(8):1046–51.
Takazakura E, Nakamoto Y, Hayakawa H, Kawai K, Muramoto S. Onset and progression of diabetic glomerulosclerosis; a prospective study based on serial renal biopsies. Diabetes. 1975;24(1):1–9.
Mauer M, Drummond K. The early natural history of nephropathy in type 1 diabetes: I. Study design and baseline characteristics of the study participants. Diabetes. 2002;51(5):1572–9.
Mauer M, Zinman B, Gardiner R, et al. Renal and retinal effects of enalapril and losartan in type 1 diabetes. N Engl J Med. 2009;361(1):40–51.
Moriya T, Yamagishi T, Matsubara M, Ouchi M. Serial renal biopsies in normo- and microalbuminuric patients with type 2 diabetes demonstrate that loss of renal function is associated with a reduction in glomerular filtration surface secondary to mesangial expansion. J Diabetes Complicat. 2019;33(5):368–73.
Klein R, Zinman B, Gardiner R, et al. The relationship of diabetic retinopathy to preclinical diabetic glomerulopathy lesions in type 1 diabetic patients: the Renin-Angiotensin System Study. Diabetes. 2005;54(2):527–33.
Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabet Med. 1988;5(2):126–34.
Marshall SM, Alberti KG. Comparison of the prevalence and associated features of abnormal albumin excretion in insulin-dependent and non-insulin-dependent diabetes. Q J Med. 1989;70(261):61–71.
Chavers BM, Mauer SM, Ramsay RC, Steffes MW. Relationship between retinal and glomerular lesions in IDDM patients. Diabetes. 1994;43(3):441–6.
Kanauchi M, Kawano T, Uyama H, Shiiki H, Dohi K. Discordance between retinopathy and nephropathy in type 2 diabetes. Nephron. 1998;80(2):171–4.
Schwartz MM, Lewis EJ, Leonard-Martin T, Lewis JB, Batlle D. Renal pathology patterns in type II diabetes mellitus: relationship with retinopathy. The Collaborative Study Group. Nephrol Dial Transplant. 1998;13(10):2547–52.
Moriya T, Tanaka S, Kawasaki R, et al. Diabetic retinopathy and microalbuminuria can predict macroalbuminuria and renal function decline in Japanese type 2 diabetic patients: Japan Diabetes Complications Study. Diabetes Care. 2013;36(9):2803–9.
Moriya T, Matsubara M, Kishihara E, Yoshida Y, Ouchi M. Type 2 diabetic patients with diabetic retinopathy and concomitant microalbuminuria showed typical diabetic glomerulosclerosis and progressive renal dysfunction. J Diabetes Complicat. 2016;30(6):1111–6.
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Moriya, T. (2021). Renal Structural-Functional Relationships at the Early Stage of Diabetic Nephropathy Among Types 1 and 2 Diabetes: Similarity and Difference. In: Wada, T., Furuichi, K., Kashihara, N. (eds) Diabetic Kidney Disease. Springer, Singapore. https://doi.org/10.1007/978-981-15-9301-7_8
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