Renal Structure in Non Insulin-Dependent Diabetic Patients with Microalbuminuria
Although more than 50% of diabetic patients receiving renal replacement therapy have type 2 diabetes [1–4], the renal pathology and natural history of diabetic nephropathy (DN) in type 2 diabetes has been studied much less intensely than in type 1 diabetes and thus many important questions remain unclear. The clinical manifestations of DN, proteinuria, declining glomerular filtration rate (GFR) and increasing blood pressure, are similar in type 1 and type 2 diabetes [5–6], as in many other renal diseases; nevertheless whether these clinical features are consequences of similar underlying renal lesions is unknown. In type 1 diabetes it is generally accepted that glomerulopathy is the most important structural change, leading to progressive renal function loss [7–12]; concomitantly and roughly proportionally to the degree of glomerulopathy, the arterioles, tubules and interstitium also undergo structural changes, including hyalinosis of the arteriolar wall, thickening and reduplication of tubular basement membranes, tubular atrophy and interstitial expansion and fibrosis. [7–12]. These lesions become progressive and severe only when glomerulopathy is far advanced. Quantitative morphometric studies have demonstrated that the lesion most closely related to the decline in renal function in type 1 diabetes is mesangial expansion, caused especially by mesangial matrix accumulation [11,13]. Also we have recently observed, in sequential renal biopsies of type 1 diabetic patients performed 5 years apart, that the only structural change associated with increasing albuminuria was mesangial expansion ; GBM width, interstitial expansion and the number of globally sclerosed glomeruli did not change over 5 years in this group of patients, several of whom were studied while in transition from normal to microalbuminuria or from microalbuminuria to overt nephropathy. Thus in type 1 diabetes severe arteriolar, tubular and interstitial lesions are rare unless advanced diabetic glomerulopathy is present.
KeywordsDiabetic Nephropathy Overt Nephropathy Tubular Basement Membrane Mesangial Expansion Renal Structure
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