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Title: | Renal structure in normoalbuminuric and albuminuric patients with type 2 diabetes and impaired renal function. | Authors: | Fioretto P.;Baker S.T.;MacIsaac R.J.;Ekinci E.I.;Jerums G.;Skene A.;Crammer P.;Power D.;Cheong K.Y.;Panagiotopoulos S.;McNeil K. | Institution: | (Ekinci, Jerums, Cheong, Panagiotopoulos, McNeil, Baker) Endocrine Centre, Austin Health, Melbourne, VIC, Australia (Ekinci, Jerums, Power, Baker) Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia (Ekinci) Menzies School of Health Research, Darwin, NT, Australia (Skene) Anatomical Pathology, Austin Health, Melbourne, VIC, Australia (Crammer) Anatomical Pathology, Southern Health, Melbourne, VIC, Australia (Power) Department of Nephrology, Austin Health, Melbourne, VIC, Australia (Fioretto) Department of Internal Medicine, University of Padova, Padova, Italy (MacIsaac) Department of Endocrinology and Diabetes, St. Vincent's Health Fitzroy, University of Melbourne, Melbourne, VIC, Australia | Issue Date: | 31-Jan-2014 | Copyright year: | 2013 | Publisher: | American Diabetes Association Inc. (1701 North Beauregard St., Alexandria VA 22311, United States) | Place of publication: | United States | Publication information: | Diabetes Care. 36 (11) (pp 3620-3626), 2013. Date of Publication: November 2013. | Abstract: | OBJECTIVE-The structural basis of normoalbuminuric renal insufficiency in patients with type 2 diabetes remains to be elucidated. We compared renal biopsy findings in patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) and measured GFR of <60 mL/min/1.73 m2, associated with either normo-, micro-, or macroalbuminuria. RESEARCH DESIGN AND METHODS-In patients with normo- (n = 8) ormicroalbuminuria (n = 6), renal biopsies were performed according to a research protocol. In patients with macroalbuminuria (n = 17), biopsies were performed according to clinical indication. Findings were categorized according to the Fioretto classification: category 1 (C1), normal/near normal; category 2 (C2), typical diabetic nephropathy (DN)with predominantly glomerular changes; and category 3 (C3), atypical with disproportionately severe interstitial/tubular/vascular damage and with no/mild diabetic glomerular changes. RESULTS-In our study population (mean eGFR 35 mL/min/1.73 m2), typical glomerular changes (C2) of DN were observed in 22 of 23 subjects with micro- or macroalbuminuria compared with 3 of 8 subjects with normoalbuminuria (P = 0.002). By contrast, predominantly interstitial or vascular changes (C3) were seen in only 1 of 23 subjects with micro- or macroalbuminuria compared with 3 of 8 normoalbuminuric subjects (P = 0.08). Mesangial area increased progressively fromnormal controls to patients with type 2 diabetes and normo-, micro-, and macroalbuminuria. Varying degrees of arteriosclerosis, although not necessarily the predominant pattern, were seen in seven of eight subjects with normoalbuminuria. CONCLUSIONS-Typical renal structural changes of DN were observed in patients with type 2 diabetes and elevated albuminuria. By contrast, in normoalbuminuric renal insufficiency, these changes were seen less frequently, likely reflecting greater contributions from aging, hypertension, and arteriosclerosis. © 2013 by the American Diabetes Association. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.2337/dc12-2572 | Link to associated publication: | Click here for full text options | PubMed URL: | 23835690 [http://www.ncbi.nlm.nih.gov/pubmed/?term=23835690] | ISSN: | 0149-5992 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/27567 | Type: | Article | Subjects: | *diabetic nephropathy/et [Etiology] disease classification disease course female glomerulonephritis/co [Complication] glomerulonephritis/di [Diagnosis] glomerulonephritis/et [Etiology] glomerulopathy/co [Complication] glomerulopathy/di [Diagnosis] glomerulopathy/et [Etiology] glomerulus filtration rate hematuria histopathology human hyaline degeneration/co [Complication] hyaline degeneration/di [Diagnosis] hyaline degeneration/et [Etiology] hypertension immunoglobulin A nephropathy/co [Complication] immunoglobulin A nephropathy/di [Diagnosis] immunoglobulin A nephropathy/et [Etiology] kidney hypertrophy/et [Etiology] *kidney structure macroalbuminuria male microalbuminuria nephrosclerosis/co [Complication] nephrosclerosis/di [Diagnosis] nephrosclerosis/et [Etiology] *non insulin dependent diabetes mellitus pathophysiology sex difference smoking antinuclear antibody/ec [Endogenous Compound] glomerular basement membrane thickness/co [Complication] glomerular basement membrane thickness/di [Diagnosis] glomerular basement membrane thickness/et [Etiology] trend study interstitial nephritis/co [Complication] interstitial nephritis/di [Diagnosis] interstitial nephritis/et [Etiology] kidney amyloidosis/co [Complication] kidney amyloidosis/di [Diagnosis] kidney amyloidosis/et [Etiology] *kidney biopsy *kidney dysfunction/co [Complication] *kidney dysfunction/di [Diagnosis] *kidney dysfunction/et [Etiology] kidney failure/co [Complication] kidney failure/di [Diagnosis] kidney failure/et [Etiology] kidney hypertrophy/co [Complication] kidney hypertrophy/di [Diagnosis] aged *albuminuria article clinical article cryoglobulinemia *diabetic nephropathy/co [Complication] *diabetic nephropathy/di [Diagnosis] glomerulopathy / complication / diagnosis / etiology glomerulus filtration rate hematuria histopathology human hyaline degeneration / complication / diagnosis / etiology hypertension immunoglobulin A nephropathy / complication / diagnosis / etiology interstitial nephritis / complication / diagnosis / etiology kidney amyloidosis / complication / diagnosis / etiology *kidney biopsy *kidney dysfunction / *complication / *diagnosis / *etiology kidney failure / complication / diagnosis / etiology kidney hypertrophy / complication / diagnosis / etiology *kidney structure macroalbuminuria male microalbuminuria nephrosclerosis / complication / diagnosis / etiology *non insulin dependent diabetes mellitus pathophysiology sex difference smoking trend study disease course disease classification *diabetic nephropathy / *complication / *diagnosis / *etiology cryoglobulinemia clinical article article *albuminuria aged female glomerulonephritis / complication / diagnosis / etiology |
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