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Pathology of the Kidney in Diabetes

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Diabetic Nephropathy

Abstract

In a classical paper published in 1936, Kimmelstiel and Wilson for the first time described mesangial expansion and nodular glomerulosclerosis in diabetic kidney disease (DKD). We have since learned much more about DKD lesions, although natural history of progression of these lesions is better known in type 1 diabetes, while majority of patients with DKD suffer from type 2 diabetes, calling for further studies in the latter population. The pathology of DKD is also more homogeneous in type 1 diabetes, and there is some controversy if all kidney lesions observed in type 2 are attributable to diabetes or they may be related to concurrent conditions such as aging, hypertension, and atherosclerosis which are commonly present in type 2 diabetic patients. For these reasons, we will initially discuss pathology of DKD in type 1 diabetic patients and then provide comparisons with type 2 diabetes. Then, we move to the natural history of DKD progression and relationships between structural changes, renal dysfunction, and diabetes duration. Finally, reversal of DKD lesions following long-term normoglycemia after pancreas transplantation and animal models of DKD are discussed.

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  1. Department of Pathology, University of Washington Medical Center, Seattle, WA, USA

    Behzad Najafian & Charles E. Alpers

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  1. Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    Joris J. Roelofs

  2. Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    Liffert Vogt

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Najafian, B., Alpers, C.E. (2019). Pathology of the Kidney in Diabetes. In: Roelofs, J., Vogt, L. (eds) Diabetic Nephropathy. Springer, Cham. https://doi.org/10.1007/978-3-319-93521-8_8

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