Renal Structure in Non Insulin Dependent Diabetic Patients with Microalbuminuria
Although far more than 50 % of diabetic patients receiving renal replacement therapy have type 2 diabetes [1–5], the renal pathology and natural history of diabetic nephropathy (DN) in type 2 diabetes has been studied much less intensly than in type 1 diabetes and thus many important questions remain unclear. The clinical manifestations of DN, proteinuria, declining GFR and increasing blood pressure, are similar in type 1 and type 2 diabetes [6–7], as they are in many other renal diseases; nevertheless whether these clinical features are the consequences of similar underlying renal lesions is not entirely known. In type 1 diabetes it is generally accepted that glomerulopathy represents the most important structural change, leading to progressive renal function loss [8–13]; 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 [8–14]. 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 predominantly by mesangial matrix accumulation [12, 15].
KeywordsDiabetic Nephropathy Diabetic Retinopathy Albumin Excretion Rate Overt Nephropathy Tubular Basement Membrane
Unable to display preview. Download preview PDF.
- 2.Stephen SGW, Gillaspry JA, Clyne D, Mejia A, Pollok VE. Racial differences in the incidence of end stage renal disease in type 1 and type 2 diabetes mellitus. Am J Kidney Dis 1990; 15: 562–567.Google Scholar
- 5.Mauer M, Mogensen CE, Friedman E. Diabetic Nephropathy. In: Schrier RW, Gottschalk CW(eds). Diseases of the kidne, 6th edn. Little Brown & Co. 1996, Vol 3, pp 2019–2062.Google Scholar
- 7.Shmitz A. Nephropathy in non-insulin dependent diabetes mellitus and perspectives for intervention. Diab Nutr Metab 1995; 7:135–148.Google Scholar
- 9.Fioretto P, Mogensen CE, Mauer SM. Diabetic nephropathy. In: Pediatric nephroplogy, ed Holliday MA, Barratt TM, Avner ED, New York, Williams and Wilkins, 1994; 576–585.Google Scholar
- 18.Kahn S, Seghal V, Appel GB, D’Agati V. Correlates of diabetic and non-diabetic renal disease in NIDDM JASN 1995; 6:451(Abs).Google Scholar
- 22.Moiya T, Moriya R, Yajima Y, Steffes MW, Mauer M. Urinary albumin excretion is a weaker predictor of diabetic nephropathy lesions in Japanese NIDDM patients than in Caucasian IDDM patients. JASN, 1997,8116A:(abs).Google Scholar
- 24.Fioretto P, Mauer M, Velussi M, Carraro A, Muollo B, Brocoo E, Baggio B, Crepaldi G, Nosadini R. Ultrastructural measures of glomerular extracellular matrix accumulation in non-proteinuric type 2 diabetic patients. JASN 1996,7:1356.Google Scholar
- 27.Mogensen CE, Christensen CK. Predicting diabetic nephropathy in insulin-dependent diabetic patients. N Engl J Med 1986;331:89–93.Google Scholar
- 34.Ruggenenti P, Mosconi L, Bianchi L, Cortesi L, Campania M, Pagani G, Mecca G, Remuzzi G. Long-term treatment with either Enalapril or Nitrendipine stabilizes albuminuria and increases glomerular filtration rate in non-insulin-dependent diabetic patients. Am J Kidney Dis 1994; 24: 753–761.PubMedGoogle Scholar
- 36.Brocco E, Fioretto P, Mauer M, Sailer A, Carraro A, Frigato F, Chiesura-Corona M, et al. Renal structure and function in non-insulin dependent diabetic patients with microalbuminuria. Kidney Int, 1997; 52, suppl. 63:40–44.Google Scholar
- 39.Ellis EN, Basgen JM, Mauer SM, Steifes MW. Kidney biopsy technique an evaluation. In Methods in Diabetes Research, Volume II Clinical Methods. Clarke WL, Lamer J, Pohl SL, Eds. New York, John Wiley & Sons, 1986; 633–47.Google Scholar