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The relationship between the thickness of glomerular basement membrane and renal outcomes in patients with diabetic nephropathy

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Abstract

Aims

Glomerular basement membrane (GBM) thickening is considered as one of the earliest detectable pathological features of diabetic nephropathy (DN). However, whether the thickness of GBM will impact the prognosis of DN remains largely unknown. Our aim was to explore the relationship between thickness of GBM and DN progression in patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 118 patients with T2DM and biopsy-proven DN who received follow-up for at least 1 year were recruited. The patients were divided into two groups according to the median (787 nm) of the GBM thickness: Group 1: GBM thickness < 787 nm (n = 59), and Group 2: GBM thickness ≥ 787 nm (n = 59). The GBM width was estimated by the direct GBM measurements as recently modified by Haas. Renal outcomes were defined by progression to ESRD and/or doubling of serum creatinine (D-Cr). The influence of GBM thickness on renal outcomes was assessed using Cox regression.

Results

Compared with the Group 1, patients in Group 2 had more serious renal insufficiency and glomerular lesions. During the follow-up, ESRD occurred in 39.8% of patients, and 8.5% of patients progressed to D-Cr. The univariate analysis indicated the greater width of GBM the higher risk of renal outcomes in T2DM patients with DN (HR [95% CI] = 2.180 [1.246–3.814], p = 0.006). However, the multivariate COX analysis demonstrated that the GBM thickness was not an independent risk factor for progression to ESRD or D-Cr (HR [95% CI] = 0.825 [0.404–1.685], p = 0.597) when adjusting for important clinical variables and pathological findings.

Conclusions

In conclusion, the DN patients with greater width of GBM had relatively poorer renal prognosis, although it did not emerge as an independent indicator of disease progression.

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Acknowledgements

This study was supported by a Grant 81670662 from the National Natural Science Foundation of China, and a grand from National Research and Development Program (2016YFC1305502).

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Author notes

  1. Junlin Zhang and Yiting Wang have contributed equally to this work; both are first authors.

Authors and Affiliations

  1. Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China

    Junlin Zhang, Yiting Wang, Pramesh Gurung, Tingli Wang, Li Li, Rui Zhang, Hanyu Li, Ruikun Guo, Qianqian Han & Fang Liu

  2. Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, Regenerative Medicine Research Center, Chengdu, 610041, China

    Jie Zhang

  3. Division of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China

    Song Lei

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  1. Junlin Zhang
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Correspondence to Fang Liu.

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The ethics committee of West China Hospital approved this research. The study protocol was in compliance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Zhang, J., Wang, Y., Gurung, P. et al. The relationship between the thickness of glomerular basement membrane and renal outcomes in patients with diabetic nephropathy. Acta Diabetol 55, 669–679 (2018). https://doi.org/10.1007/s00592-018-1128-9

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  • DOI: https://doi.org/10.1007/s00592-018-1128-9

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