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Diabetologia

, Volume 38, Issue 11, pp 1320–1327 | Cite as

A quantitative ultrastructural study of juxtaglomerular arterioles in IDDM patients with micro- and normoalbuminuria

  • R. Østerby
  • H. -J. Bangstad
  • G. Nyberg
  • J. D. Walker
  • G C. Viberti
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Summary

Hyalinization of juxtaglomerular arterioles is prominent in advanced diabetic nephropathy and may have important functional consequences. We studied the early stages of diabetic renal disease using kidney biopsy material from insulin-dependent diabetic patients, 8 with normal albumin excretion rate (<15 Μ/min) and 16 with microalbuminuria (15–200 Μg/min). Ten living non-diabetic kidney donors served as a control group. Median duration of diabetes was 9.5 years (range 5–31) in patients with normoalbuminuria, and 12 years (7–22) in patients with microalbuminuria (p=0.27). The tissue was sectioned systematically, 1-Μm thick sections for light microscopy at 10-Μm intervals, and thin sections for electron microscopy taken at 60-Μm intervals. The arterioles were identified as afferent or efferent, and total profiles were photographed (magnification 7500×), providing a systematic independent sample for measurements using standard stereological methods. Patients with microalbuminuria had significantly increased arteriole parameters compared with the control group: for afferent and efferent arterioles the volume fraction of matrix/media, means and (coefficient of variation, CV), was 0.47 (0.16) vs 0.33 (0.19) (p=0.0009), and 0.62 (0.14) vs 0.45 (0.23) (p=0.0004) and matrix-T, expressing amount of matrix per unit arteriolar surface, 2.38 (0.38) Μm vs 1.44 (0.30) Μm (p=0.004), and 1.62 (0.28) Μm vs 1.03 (0.34) (p=0.0009). Patients with normoalbuminuria showed no significant differences from the control group, and had lower values than microalbuminuric patients for all parameters except the afferent matrix-T. In the normoalbuminuric group a correlation was found between parameters for afferent arterioles and those for glomerular structure. In conclusion there is arteriolar accumulation of extracellular material in the early phase of diabetic nephropathy, concomitant with early glomerulopathy.

Key words

Diabetic nephropathy diabetic glomerulopathy arteriolar hyalinosis juxtaglomerular arterioles extracellular matrix microalbuminuria stereology 

Abbreviations

IDDM

Insulin-dependent diabetes mellitus

GFR

glomerular filtration rate

AER

albumin excretion rate

matrix-T

matrix thickness

ND

non-diabetic subjects

DNA

IDDM patients with normal albumin excretion rate

DMI

IDDM patients with microalbuminuria

RPF

renal plasma flow

CV

coefficient of variation

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Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • R. Østerby
    • 1
  • H. -J. Bangstad
    • 2
  • G. Nyberg
    • 3
  • J. D. Walker
    • 4
  • G C. Viberti
    • 4
  1. 1.Electron Microscopy LaboratoryInstitute for Experimental Clinical Research, Medical Department M (Diabetes and Endocrinology) and University Institute of Pathology, århus KommunehospitalårhusDenmark
  2. 2.Aker Diabetes Research CentreAker University HospitalOsloNorway
  3. 3.Transplant UnitSahlgrenska University HospitalGöteborgSweden
  4. 4.Unit for Metabolic Medicine, United Medical and Dental SchoolsGuy's HospitalLondonUK

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