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Clinical and Experimental Nephrology

, Volume 22, Issue 3, pp 570–582 | Cite as

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

  • Kengo Furuichi
  • Miho Shimizu
  • Yukio Yuzawa
  • Akinori Hara
  • Tadashi Toyama
  • Hiroshi Kitamura
  • Yoshiki Suzuki
  • Hiroshi Sato
  • Noriko Uesugi
  • Yoshifumi Ubara
  • Junichi Hohino
  • Satoshi Hisano
  • Yoshihiko Ueda
  • Shinichi Nishi
  • Hitoshi Yokoyama
  • Tomoya Nishino
  • Kentaro Kohagura
  • Daisuke Ogawa
  • Koki Mise
  • Yugo Shibagaki
  • Hirofumi Makino
  • Seiichi Matsuo
  • Takashi Wada
  • Research Group of Diabetic Nephropathy, Ministry of Health, Labour and Welfare of Japan, and Japan Agency for Medical Research and Development
Original article

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.

Keywords

Japanese classification of diabetic nephropathy Kidney biopsy Nodular lesions Mesangiolysis Exudative lesions Widening of the subendothelial space 

Notes

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.

Compliance with ethical standards

Financial disclosure

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.

Supplementary material

10157_2017_1485_MOESM1_ESM.ppt (172 kb)
Supplementary material 1 (PPT 171 kb)

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Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Kengo Furuichi
    • 1
  • Miho Shimizu
    • 1
  • Yukio Yuzawa
    • 2
  • Akinori Hara
    • 1
  • Tadashi Toyama
    • 1
  • Hiroshi Kitamura
    • 3
  • Yoshiki Suzuki
    • 4
  • Hiroshi Sato
    • 5
  • Noriko Uesugi
    • 6
  • Yoshifumi Ubara
    • 7
  • Junichi Hohino
    • 7
  • Satoshi Hisano
    • 8
  • Yoshihiko Ueda
    • 9
  • Shinichi Nishi
    • 10
  • Hitoshi Yokoyama
    • 11
  • Tomoya Nishino
    • 12
  • Kentaro Kohagura
    • 13
  • Daisuke Ogawa
    • 14
  • Koki Mise
    • 14
  • Yugo Shibagaki
    • 15
  • Hirofumi Makino
    • 14
  • Seiichi Matsuo
    • 16
  • Takashi Wada
    • 17
  • Research Group of Diabetic Nephropathy, Ministry of Health, Labour and Welfare of Japan, and Japan Agency for Medical Research and Development
  1. 1.Department of NephrologyKanazawa University HospitalKanazawaJapan
  2. 2.Department of NephrologyFujita Health University HospitalToyoakeJapan
  3. 3.Department of Pathology, Clinical Research CenterNational Hospital Organization Chiba East National HospitalChibaJapan
  4. 4.Health Administration Center, Niigata UniversityNiigataJapan
  5. 5.Clinical Pharmacology and TherapeuticsTohoku University Graduate School of Pharmaceutical SciencesSendaiJapan
  6. 6.Department of Pathology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  7. 7.Nephrology Center, Toranomon HospitalMinatoJapan
  8. 8.Department of Pathology, Faculty of MedicineFukuoka UniversityFukuokaJapan
  9. 9.Department of PathologyDokkyo Medical University Koshigaya HospitalKoshigayaJapan
  10. 10.Division of Nephrology and Kidney CenterKobe University Graduate School of MedicineKobeJapan
  11. 11.Department of NephrologyKanazawa Medical University School of MedicineUchinadaJapan
  12. 12.Second Department of Internal MedicineNagasaki University School of MedicineNagasakiJapan
  13. 13.Department of Cardiovascular Medicine, Nephrology and NeurologyUniversity of the Ryukyus School of MedicineOkinawaJapan
  14. 14.Department of Nephrology, Rheumatology, Endocrinology and MetabolismOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  15. 15.Division of Nephrology and Hypertension, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
  16. 16.Division of Nephrology, Department of Internal MedicineNagoya University Graduate School of MedicineNagoyaJapan
  17. 17.Department of Nephrology and Laboratory MedicineKanazawa UniversityKanazawaJapan

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