The relationship between the thickness of glomerular basement membrane and renal outcomes in patients with diabetic nephropathy
- 162 Downloads
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).
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.
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.
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.
KeywordsGBM thickness Diabetic nephropathy Renal outcome Renal pathology
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).
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest that is relevant to this article.
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.
Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
- 22.An Y, Xu F, Le W, Ge Y, Zhou M, Chen H, Zeng C, Zhang H, Liu Z (2015) Renal histologic changes and the outcome in patients with diabetic nephropathy. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 30:257–266Google Scholar
- 30.Nosadini R, Velussi M, Brocco E, Bruseghin M, Abaterusso C, Saller A, Dalla Vestra M, Carraro A, Bortoloso E, Sambataro M, Barzon I, Frigato F, Muollo B, Chiesura-Corona M, Pacini G, Baggio B, Piarulli F, Sfriso A, Fioretto P (2000) Course of renal function in type 2 diabetic patients with abnormalities of albumin excretion rate. Diabetes 49:476–484CrossRefPubMedGoogle Scholar
- 38.Guan M, Ma J, Keaton JM, Dimitrov L, Mudgal P, Stromberg M, Bonomo JA, Hicks PJ, Freedman BI, Bowden DW, Ng MC (2016) Association of kidney structure-related gene variants with type 2 diabetes-attributed end-stage kidney disease in African Americans. Hum Genet 135:1251–1262CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Ekinci EI, Jerums G, Skene A, Crammer P, Power D, Cheong KY, Panagiotopoulos S, McNeil K, Baker ST, Fioretto P, Macisaac RJ (2013) Renal structure in normoalbuminuric and albuminuric patients with type 2 diabetes and impaired renal function. Diabetes Care 36:3620–3626CrossRefPubMedPubMedCentralGoogle Scholar