Summary
Twenty-two patients with insulin-dependent diabetes mellitus and renal involvement were submitted to renal biopsy. Mean age was 42 years; 10 were males, 12 females. The mean interval between clinical manifestation of nephropathy and biopsy was about 2 years. At the time of biopsy, 4 groups were distinguished according to clinical conditions, depending on the presence or absence of nephrotic syndrome and renal failure. Renal lesions were semiquantitatively evaluated, a separate score being considered for glomerular and vascular lesions. Immunofluorescence most frequently showed a pattern of faint linear IgG deposits along glomerular basement membranes: Severity of histological lesions and pattern of urinary abnormalities were not correlated with the duration of diabetes or the patients’ age. Both glomerular and vascular lesions were correlated with the presence of renal failure, while no relationship with the pattern of urinary abnormalities was found. Fourteen patients were followed for more than one year after biopsy: 5 had normal renal function, 4 were in chronic renal insufficiency and 5 in end-stage renal failure (3 were in dialysis, 2 died). There was no correlation between the 3 above-mentioned types of evolution and glomerular histological findings. Nevertheless a higher score of vascular impairment at biopsy was observed among patients who subsequently were found to have a more unfavorable prognosis. Therefore renal biopsy, by providing information on the degree of renal vascular damage, may have some value in predicting the clinical course of diabetic nephropathy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bader R., Bader H., Grund K. E., Mackensen H., Christ H., Bohle A.: Structure and function of the kidney in diabetic glomerulosclerosis. Correlation between morphological and functional parameters — Path. Res. Pract.167, 204, 1980.
Baladimos M. C., Legg M. A., Bradley R. F.: Diabetic glomerulosclerosis in children — Diabetes20, 622, 1971.
Barbiano di Belgiojoso G., Tarantino A., Bazzi C., Colasanti G., Guerra L., Durante A.: Immunofluorescence patterns in chronic membranoproliferative glomerulonephritis — Clin. Nephrol.1, 303, 1976.
Beisswenger P. J., Spiro R. G.: Studies on the human glomerular basement membrane. Composition, nature of the carbohydrate units and chemical changes in diabetes mellitus — Diabetes22, 18, 1973.
Berkman J., Rifkin H.: Unilateral nodular diabetic glomerulosclerosis (Kimmelstiel-Wilson): report of a case — Metabolism22, 715, 1973.
Caird F. I.: Survival in diabetics with proteinuria — Diabetes10, 178, 1961.
Cavallero C., Spagnolo L. G., Vilaschi S., Nicosia R.: Istopatologia della nefropatia diabetica. In: Nefropatia diabetica. Atti Giornate di Diabetologia del Mediterraneo, Voulagmeni 1–3 November 1975; p. 17.
Cohen M. P., Vogt C.: Evidence for enhanced basement membrane synthesis and lysine hydroxylation in renal glomerulus in experimental diabetes — Biochem. biophys. Res. Commun.49, 1542, 1972.
Deckert T., Poulsen J. E., Larsen M.: Prognosis of diabetics with diabetes onset before the age of thirty-one. I. Survival, causes of death, and complications — Diabetologia14, 363, 1978.
Deckert T., Poulsen J. E., Larsen M.: Prognosis of diabetics with diabetes onset before the age of thirty-one. II. Factors influencing the prognosis — Diabetologia14, 371, 1978.
Ditzel J., Junker K.: Abnormal glomerular filtration rate, renal plasma flow and renal protein excretion in recent and short-term diabetics — Brit. med. J.ii, 13, 1972.
Engerman R., Bloodworth J. M. B. Jr., Nelson S.: Relationship of microvascular disease in diabetes to metabolic control — Diabetes26, 760, 1977.
Farquhar M. G., Hopper J. Jr., Moon H. D.: Diabetic glomerulosclerosis: electron and light microscopic studies — Amer. J. Path.35, 721, 1959.
Freedman P., Moulton R., Spencer A. G.: Hypertension and diabetes mellitus — Quart. J. Med.27, 293, 1958.
Gellmann D. D., Pirani C., Soothill J. F., Muehrcke R. C., Kark R. M.: Diabetic nephropathy: a clinical study based on renal biopsies — Medicine (Baltimore)28, 321, 1959.
Jones R. H., Hayakawa M., McCoy J., Parsons U., Watkins P. J.: Progression of diabetic neophropathy — Lanceti, 1105, 1979.
Kamenetzky S., Bennett P. H., Dippe S. E., Miller M., LeCompte P. M.: A clinical and histological study of diabetic nephropathy in the Pima Indians — Diabetes23, 61, 1974.
Kawano K., Arakawa M., McCoy J., Porgh J., Kimmestiel P.: Quantitative study of glomeruli, focal glomerulonephritis and diabetic glomerulosclerosis — Lab. Invest.21, 269, 1969.
Keen H., Track N. S., Sawary G. S. C.: Arterial pressure in clinically apparent diabetics — Diabète et Métab.1, 159, 1975.
Keen H., Viberti G. C., Mackintosh D.: The early features of diabetic nephropathy. In: Séminaire d’Uro-Néphrologie de l’Hôpital Pitié-Salpetrière, Paris 1982; p. 195.
Kefalides N. A.: Biochemical properties of human glomerular basement membrane in normal and diabetic kidney — J. clin. Invest.53, 403, 1974.
Klein L., Butcher D. L., Sudilovsky O., Kikkawa R., Miller M.: Quantification of collagen in renal glomeruli isolated from human non-diabetic and diabetic kidneys — Diabetes24, 1057, 1975.
Kussman M. J., Goldstein M. M., Gleason R. E.: The clinical course of diabetic nephropathy — J. Amer. med. Ass.236, 1861, 1976.
Knowles H. C. Jr.: Magnitude of the renal failure problem in diabetic patients. In:Shapiro F. L., Kjellstrand C. M., Goetz F. C. (Eds): End-stage diabetic nephropathy — Kidney int.6 (Suppl.), S-2, 1974.
Lundbaek K.: The kidney in diabetes. In:Hamburger J., Crosnier S. M., Grundfeld J. P. (Eds): Néphrologie. Flammarion Éd., Paris, 1979.
Mauer S. M., Steffes M. W., Brown D. M.: The kidney in diabetes — Amer. J. Med.70, 603, 1981.
Mauer S. M., Steffes M. W., Sutherland D. E. R., Najarian J. S., Michael A. F., Brown D. M.: Studies of the rate of regression of the glomerular lesions in diabetic rats treated with pancreatic islet transplantation — Diabetes24, 280, 1975.
McMillan D.: Renal vascular changes in diabetics and their predicted effects — Acta endocr. (Kbh.)97 (Suppl. 242), 26, 1981.
Miki E., Kuzuya T., Nakai K.: Frequency, degree and progression with time of proteinuria in diabetic patients — Lanceti, 922, 1972.
Miller K., Michael A. F.: Immunopathology of renal extracellular membranes in diabetes mellitus. Specificity of tubular basement-membrane immunofluorescence — Diabetes25, 701, 1976.
Mogensen C. E.: Progression of nephropathy in long-term diabetics with proteinuria and effect of initial anti-hypertensive treatment — Scand. J. clin. Lab. Invest.36, 383, 1976.
Mogensen C. E.: Diabetes and hypertension — Lanceti, 388, 1979.
Østerby R.: Early phases in development of diabetic glomerulopathy. A quantitative electron microscope study — Acta med. scand.574 (Suppl.), 1, 1975.
Papper S., DeWayne A.: Diabetic glomerulosclerosis — Contrib. Nephrol.7, 97, 1977.
Parving H.-H., Andersen A. R., Smidt U. M., Friisberg B., Svendsen P. Aa.: Reduced albuminuria during early and aggressive antihypertensive treatment of insulin-dependent diabetic patients with diabetic nephropathy — Diabetes Care4, 459, 1981.
Parving H.-H., Smidt U. M., Friisberg B., Bonnevie-Nielsen V., Andersen A. R.: Prospective study of glomerular filtration rate and arterial blood pressure in insulin-dependent diabetics with diabetic nephropathy — Diabetologia20, 457, 1981.
Platz P., Thomsen M., Suggaard A., Cudworth A. G., Woodrow J. C., Nerup J.: More on the genetics of juvenile diabetes — New Engl. J. Med.298, 1200, 1978.
Rasch R.: Prevention of diabetic glomerulopathy in streptozotocin diabetic rats by insulin treatment. The mesangial regions — Diabetologia17, 243, 1979.
Raskin P.: Diabetic regulation and its relationship to microangiopathy — Metabolism27, 235, 1978.
Robbins S. L., Tucker A. W. Jr.: The cause of death in diabetes. A report of 307 autopsied cases — New Engl. J. Med.231, 865, 1944.
Siperstein M. D., Unger R. H., Madison L. L.: Studies of muscle capillary basement membranes in normal subjects, diabetic and pre-diabetic patients — J. clin. Invest.47, 1973, 1978.
Spiro M. J., Spiro R. G.: Studies on the biosynthesis of hydroxylysine linked disaccharide unit of basement membranes and collagen — J. biol. Chem.246, 4910, 1971.
Spiro R. G.: Search for a biomedical basis of diabetic microangiopathy — Diabetologia12, 1, 1976.
Steffes M. W., Brown D. M., Mauer S. M.: Diabetic glomerulopathy following unilateral nephrectomy in the rat — Diabetes27, 35, 1978.
Steno Study Group: Effect of 6 months of strict metabolic control on eye and kidney function in insulin dependent diabetics with background retinopathy — Lanceti, 121, 1982.
Takazakura E., Nakamoto Y., Hoyakawa H., Kawai K., Muramoto S., Yoshida K., Shimizu M., Shinoda A., Takeuchi J.: Onset and progression of diabetic glomerulosclerosis. A prospective study based on serial renal biopsies — Diabetes24, 1, 1975.
Watkins P. J., Blainey J. D., Brewer D. B., Fitzgerald M. G., Malins J. M., Sullivan D. J., Pinto J. A.: The natural history of diabetic renal disease. A follow up of series of renal biopsies — Quart. J. Med.41, 437, 1972.
Watkins P. J., Parsons V., Benick M.: The prognosis and management of diabetic nephropathy — Clin. Nephrol.7, 243, 1977.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bertoli, S., Bottelli, R., Confalonieri, R. et al. Diabetic nephropathy: Clinical and histological study in 22 patients. Acta diabet. lat 20, 125–133 (1983). https://doi.org/10.1007/BF02624913
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02624913