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Clinicopathological analysis of biopsy-proven diabetic nephropathy based on the Japanese classification of diabetic nephropathy

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Abstract

Background

The Japanese classification of diabetic nephropathy reflects the risks of mortality, cardiovascular events and kidney prognosis and is clinically useful. Furthermore, pathological findings of diabetic nephropathy are useful for predicting prognoses. In this study, we evaluated the characteristics of pathological findings in relation to the Japanese classification of diabetic nephropathy and their ability to predict prognosis.

Methods

The clinical data of 600 biopsy-confirmed diabetic nephropathy patients were collected retrospectively from 13 centers across Japan. Composite kidney events, kidney death, cardiovascular events, all-cause mortality, and decreasing rate of estimated GFR (eGFR) were evaluated based on the Japanese classification of diabetic nephropathy.

Results

The median observation period was 70.4 (IQR 20.9–101.0) months. Each stage had specific characteristic pathological findings. Diffuse lesions, interstitial fibrosis and/or tubular atrophy (IFTA), interstitial cell infiltration, arteriolar hyalinosis, and intimal thickening were detected in more than half the cases, even in Stage 1. An analysis of the impacts on outcomes in all data showed that hazard ratios of diffuse lesions, widening of the subendothelial space, exudative lesions, mesangiolysis, IFTA, and interstitial cell infiltration were 2.7, 2.8, 2.7, 2.6, 3.5, and 3.7, respectively. Median declining speed of eGFR in all cases was 5.61 mL/min/1.73 m2/year, and the median rate of declining kidney function within 2 years after kidney biopsy was 24.0%.

Conclusions

This study indicated that pathological findings could categorize the high-risk group as well as the Japanese classification of diabetic nephropathy. Further study using biopsy specimens is required to clarify the pathogenesis of diabetic kidney disease.

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Acknowledgements

This study was supported in part by a Grant-in-Aid for Diabetic Nephropathy and Nephrosclerosis Research from the Ministry of Health, Labour and Welfare of Japan and Grant-in-Aid for Practical Research Project for Renal Diseases, from the Japan Agency for Medical Research and Development (no. 15ek0310003h0001). This work was also supported in part by Grants-in-Aids from the Ministry of Education, Culture, Sports, Science, and Technology of the Japanese Government.

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Authors and Affiliations

  1. Department of Nephrology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Kengo Furuichi, Miho Shimizu, Akinori Hara & Tadashi Toyama

  2. Department of Nephrology, Fujita Health University Hospital, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan

    Yukio Yuzawa

  3. Department of Pathology, Clinical Research Center, National Hospital Organization Chiba East National Hospital, 673 Nitona, Chiba, Chiba, 260-8712, Japan

    Hiroshi Kitamura

  4. Health Administration Center, Niigata University, 2-8085, Igarashi, Nishi-ku, Niigata, Niigata, 950-2181, Japan

    Yoshiki Suzuki

  5. Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences, 6-3 Aoba, Aramaki, Aoba-ku, Sendai, 980-8578, Japan

    Hiroshi Sato

  6. Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan

    Noriko Uesugi

  7. Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato, Tokyo, 105-8470, Japan

    Yoshifumi Ubara & Junichi Hohino

  8. Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Satoshi Hisano

  9. Department of Pathology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan

    Yoshihiko Ueda

  10. Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Shinichi Nishi

  11. Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan

    Hitoshi Yokoyama

  12. Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Tomoya Nishino

  13. Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus School of Medicine, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan

    Kentaro Kohagura

  14. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Daisuke Ogawa, Koki Mise & Hirofumi Makino

  15. Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

    Yugo Shibagaki

  16. Division of Nephrology, Department of Internal Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Seiichi Matsuo

  17. Department of Nephrology and Laboratory Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Takashi Wada

Authors
  1. Kengo Furuichi
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  2. Miho Shimizu
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  3. Yukio Yuzawa
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  4. Akinori Hara
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  5. Tadashi Toyama
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  6. Hiroshi Kitamura
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  7. Yoshiki Suzuki
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  8. Hiroshi Sato
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  9. Noriko Uesugi
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  10. Yoshifumi Ubara
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  11. Junichi Hohino
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  12. Satoshi Hisano
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  13. Yoshihiko Ueda
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  14. Shinichi Nishi
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  15. Hitoshi Yokoyama
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  16. Tomoya Nishino
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  17. Kentaro Kohagura
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  18. Daisuke Ogawa
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  19. Koki Mise
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  20. Yugo Shibagaki
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  21. Hirofumi Makino
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  22. Seiichi Matsuo
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  23. Takashi Wada
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Consortia

Research Group of Diabetic Nephropathy, Ministry of Health, Labour and Welfare of Japan, and Japan Agency for Medical Research and Development

Corresponding author

Correspondence to Takashi Wada.

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All authors; none

Conflict of interest

The authors have declared that no conflict of interest exists.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (the medical ethics committee of Kanazawa University, Approval No. 1204) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Furuichi, K., Shimizu, M., Yuzawa, Y. et al. Clinicopathological analysis of biopsy-proven diabetic nephropathy based on the Japanese classification of diabetic nephropathy. Clin Exp Nephrol 22, 570–582 (2018). https://doi.org/10.1007/s10157-017-1485-7

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  • DOI: https://doi.org/10.1007/s10157-017-1485-7

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