Abstract
The increasing prevalence of diabetes worldwide has led to a concomitant rise in diabetic kidney disease (DKD) as a major cause of end-stage renal disease. Glomerular lesions constitute the most striking and consistent features identified in biopsies from patients with DKD, although tubulointerstitial injury has an important and often under-recognized role in the progression to overt nephropathy. In advanced stages of the disease, podocyte detachment is a pivotal event in the loss of glomerular filtration barrier integrity and may explain, at least in part, the inability of current therapies to halt renal function decline. This chapter details the systematic method that can be used to study renal tissue samples from diabetic patients, and the specific role of different imaging techniques, such as light microscopy, immunofluorescence microscopy, and transmission and scanning electron microscopy in detecting histologic lesions specific to DKD.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Afkarian M, Zelnick LR, Hall YN, Heagerty PJ, Tuttle K, Weiss NS, de Boer IH (2016) Clinical manifestations of kidney disease among us adults with diabetes, 1988-2014. JAMA 316(6):602–610. https://doi.org/10.1001/jama.2016.10924
WHO: Global status report on noncommunicable diseases 2014. http://www.who.int/nmh/publications/ncd-status-report-2014/en/
Chen L, Magliano DJ, Zimmet PZ (2011) The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nat Rev Endocrinol 8(4):228–236. https://doi.org/10.1038/nrendo.2011.183
Ritz E, Zeng XX, Rychlik I (2011) Clinical manifestation and natural history of diabetic nephropathy. Contrib Nephrol 170:19–27. https://doi.org/10.1159/000324939
Porrini E, Ruggenenti P, Mogensen CE, Barlovic DP, Praga M, Cruzado JM, Hojs R, Abbate M, de Vries AP (2015) Non-proteinuric pathways in loss of renal function in patients with type 2 diabetes. Lancet Diabetes Endocrinol 3(5):382–391. https://doi.org/10.1016/S2213-8587(15)00094-7
Fioretto P, Mauer M (2007) Histopathology of diabetic nephropathy. Semin Nephrol 27(2):195–207. https://doi.org/10.1016/j.semnephrol.2007.01.012
Fioretto P, Caramori ML, Mauer M (2008) The kidney in diabetes: dynamic pathways of injury and repair. The Camillo Golgi Lecture 2007. Diabetologia 51(8):1347–1355. https://doi.org/10.1007/s00125-008-1051-7
Alicic RZ, Rooney MT, Tuttle KR (2017) Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol 12(12):2032–2045. https://doi.org/10.2215/CJN.11491116
Najafian B, Alpers CE, Fogo AB (2011) Pathology of human diabetic nephropathy. In: Ronco C (ed) Contributions to nephrology, vol 170. Karger, Basel, pp 36–47. https://doi.org/10.1159/000324942
Conti S, Perico N, Novelli R, Carrara C, Benigni A, Remuzzi G (2018) Early and late scanning electron microscopy findings in diabetic kidney disease. Sci Rep 8(1):4909. https://doi.org/10.1038/s41598-018-23244-2
Sharma SG, Bomback AS, Radhakrishnan J, Herlitz LC, Stokes MB, Markowitz GS, D’Agati VD (2013) The modern spectrum of renal biopsy findings in patients with diabetes. Clin J Am Soc Nephrol 8(10):1718–1724. https://doi.org/10.2215/CJN.02510213
Gambara V, Mecca G, Remuzzi G, Bertani T (1993) Heterogeneous nature of renal lesions in type II diabetes. J Am Soc Nephrol 3:1458–1466
Gluck C, Ko YA, Susztak K (2017) Precision medicine approaches to diabetic kidney disease: tissue as an issue. Curr Diab Rep 17(5):30. https://doi.org/10.1007/s11892-017-0854-7
Fioretto P, Steffes MW, Sutherland DE, Goetz FC, Mauer M (1998) Reversal of lesions of diabetic nephropathy after pancreas transplantation. N Engl J Med 339(2):69–75
Pichaiwong W, Hudkins KL, Wietecha T, Nguyen TQ, Tachaudomdach C, Li W, Askari B, Kobayashi T, O’Brien KD, Pippin JW, Shankland SJ, Alpers CE (2013) Reversibility of structural and functional damage in a model of advanced diabetic nephropathy. J Am Soc Nephrol 24(7):1088–1102
Andeen NK, Nguyen TQ, Steegh F, Hudkins KL, Najafian B, Alpers CE (2015) The phenotypes of podocytes and parietal epithelial cells may overlap in diabetic nephropathy. Kidney Int 88(5):1099–1107. https://doi.org/10.1038/ki.2015.273
Suvarna K, Layton C, Bancroft J (2012) Bancroft’s theory and practice of histological techniques, 7th edn. Churchill Livingstone Elsevier, London
Nakakoshi M, Nishioka H, Katayama E (2011) New versatile staining reagents for biological transmission electron microscopy that substitute for uranyl acetate. J Electron Microsc 60(6):401–407. https://doi.org/10.1093/jmicro/dfr084
Jennette JC (1998) Crescentic glomerulonephritis. In: Jennette JC, Olson JL, Schwarz M, Silva FG (eds) Heptinstall’s pathology of the kidney, 5th edn. Lippincott-Raven, New York
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Science+Business Media, LLC, part of Springer Nature
About this protocol
Cite this protocol
Carrara, C., Abbate, M., Conti, S., Rottoli, D., Rizzo, P., Marchetti, G. (2020). Histological Examination of the Diabetic Kidney. In: Gnudi, L., Long, D. (eds) Diabetic Nephropathy. Methods in Molecular Biology, vol 2067. Humana, New York, NY. https://doi.org/10.1007/978-1-4939-9841-8_6
Download citation
DOI: https://doi.org/10.1007/978-1-4939-9841-8_6
Published:
Publisher Name: Humana, New York, NY
Print ISBN: 978-1-4939-9840-1
Online ISBN: 978-1-4939-9841-8
eBook Packages: Springer Protocols