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Clinicopathological features and outcomes of diabetic kidney disease with extracapillary hypercellularity: a Japanese single-center experience

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The prognostic significance of glomerular extracapillary hypercellularity (EXHC) in diabetic kidney disease (DKD) is unclear. The aim of this study was to investigate the clinicopathological features and outcomes of DKD patients with EXHC.


We studied 70 cases of renal biopsy-confirmed type 2 DKD that were diagnosed between 2004 and 2014 and compared the clinicopathological features and outcomes of 22 patients with EXHC (EXHC group) with those of 48 patients without EXHC (control group). All of the patients were Japanese. We assessed the renal biopsy specimens based on the Renal Pathology Society classification system. Clinical and laboratory data were collected at the time of the renal biopsy, and renal outcomes were assessed based on progression to end-stage renal disease (ESRD) requiring renal replacement therapy. The median duration of the observation period was 3 years.


In pathological features, nodular sclerosis (Kimmelstiel–Wilson lesions) was observed more frequently in the EXHC group than in the control group (63.6% vs. 35.4%, P = 0.027). There were no significant intergroup differences in clinical features or renal outcomes. Univariate and multivariate Cox regression analyses of all patients showed that a high level of proteinuria, a low initial eGFR, and severe interstitial inflammation were poor prognostic factors.


EXHC is related to nodular sclerosis, which is a known risk factor for ESRD. Careful observation is needed during the follow-up of DKD patients with EXHC, although there were no significant differences in renal outcomes between the EXHC and control groups.

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This study was supported in part by Akita Jinfuzen Kenkyukai. The authors thank all of the doctors at our affiliated hospitals for referring the patients.

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Correspondence to Ayano Saito.

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All authors declare that they have no conflicts of interest.

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All of the procedures performed in studies involving human participants were carried out in accordance with the ethical standards of the relevant institutional and/or national research committees (institutional review board approval number: 1026) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in this study.

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Saito, A., Komatsuda, A., Saito, M. et al. Clinicopathological features and outcomes of diabetic kidney disease with extracapillary hypercellularity: a Japanese single-center experience. Clin Exp Nephrol (2020). https://doi.org/10.1007/s10157-020-01859-y

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  • Clinicopathological study
  • Crescent
  • Diabetic kidney disease
  • Extracapillary hypercellularity
  • Prognosis