Arteriolar Hyalinosis Predicts Increase in Albuminuria and GFR Decline in Normo- and Microalbuminuric Japanese Patients With Type 2 Diabetes

Moriya, Takuya; Omura, Kazuki; Matsubara, Madoka; Yoshida, Yuki; Hayama, Koremasa; Ouchi, Motoshi

doi:10.2337/dc17-0209

Cited by 28 publications

(23 citation statements)

References 26 publications

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“…10 In a Japanese study of 29 individuals with type 2 diabetes and normo-or microalbuminuria at kidney biopsy followed for 8.063.5 years, higher baseline Vv(Mes/glom) was associated with lower GFR at follow-up, but no structural measures were associated with GFR slope. 33 Because of the differing levels of kidney function at biopsy, variable lengths of follow-up, and the differing outcome definitions, direct comparisons between studies are difficult. However, these studies generally support associations of kidney function decline with GBM width and Vv(Mes/glom), as reported in this study.…”

Section: Discussionmentioning

confidence: 99%

Changes in Albuminuria But Not GFR are Associated with Early Changes in Kidney Structure in Type 2 Diabetes

Looker

Mauer

Saulnier

et al. 2019

JASN

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BackgroundIn type 1 diabetes, changes in the GFR and urine albumin-to-creatinine ratio (ACR) are related to changes in kidney structure that reflect disease progression. However, such changes have not been studied in type 2 diabetes.MethodsParticipants were American Indians with type 2 diabetes enrolled in a clinical trial of losartan versus placebo. We followed a subset who underwent kidney biopsy at the end of the 6-year trial, with annual measurements of GFR (by urinary clearance of iothalamate) and ACR. Participants had a second kidney biopsy after a mean follow-up of 9.3 years. We used quantitative morphometric analyses to evaluate both biopsy specimens.ResultsBaseline measures for 48 participants (12 men and 36 women, mean age 45.6 years) who completed the study included diabetes duration (14.6 years), GFR (156 ml/min), and ACR (15 mg/g). During follow-up, glomerular basement membrane (GBM) width, mesangial fractional volume, and ACR increased, and surface density of peripheral GBM and GFR decreased. After adjustment for sex, age, ACR, and each morphometric variable at baseline, an increase in ACR during follow-up was significantly associated with increases in GBM width, mesangial fractional volume, and mean glomerular volume, and a decrease in surface density of peripheral GBM. Decline in GFR was not associated with changes in these morphometric variables after additionally adjusting for baseline GFR.ConclusionsIn American Indians with type 2 diabetes and preserved GFR at baseline, increasing ACR reflects the progression of earlier structural glomerular lesions, whereas early GFR decline may not accurately reflect such lesions.

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Section: Discussionmentioning

confidence: 99%

Changes in Albuminuria But Not GFR are Associated with Early Changes in Kidney Structure in Type 2 Diabetes

Looker

Mauer

Saulnier

et al. 2019

JASN

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“…Moreover, interstitial fibrosis, tubular atrophy, and arteriosclerosis in renal biopsy specimens are the pathological factors to develop kidney events [ 56 ]. Besides arteriosclerosis, arteriolar hyalinosis is related to global glomerular sclerosis because it reduces the glomerular blood flow [ 103 ] and has been found to be a histological predictor for GFR decline in diabetic patients with normoalbuminuria [ 104 ].…”

Section: Pathogenesismentioning

confidence: 99%

“…More significant heterogeneity in renal structural changes of NADRI (atypical tubulointerstitial and vascular lesions) than in ADRI suggested aging may be one of the key contributors to the atypical nephropathy changes observed in NADRI and contributes to decline in kidney function independently of albuminuria [ 58 ]. In particular, hyaline arteriolosclerosis is a characteristic of ‘age-related vasculopathy’ and is related to global glomerular sclerosis [ 107 ], which is a histological predictor for GFR decline in normoalbuminuric patients with T2DM [ 104 ].…”

Section: Pathogenesismentioning

confidence: 99%

Update on pathogenesis and diagnosis flow of normoalbuminuric diabetes with renal insufficiency

Deng

2021

Eur J Med Res

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In recent decades, the prevalence of diabetic kidney disease has remained stable and appears to be a wide heterogeneity. Normoalbuminuric diabetes with renal insufficiency, which is characterized by a decline in the glomerular filtration rate in the absence of albuminuria, has been identified as an albuminuria-independent phenotype of diabetic kidney disease. Epidemiological data demonstrate that normoalbuminuric phenotype is prevalent. Compared to albuminuric phenotype, normoalbuminuric phenotype has distinct clinical characteristics and a wide heterogeneity of pathological features. Currently, the pathogenesis of normoalbuminuric phenotype remains unclear. Additionally, the flow of diagnosing normoalbuminuric phenotype is not perfect. In this article, we review the latest studies addressing the epidemiology, clinical characteristics, and pathology of normoalbuminuric phenotype. Based on the studies of clinical features and renal histopathologic changes, we attempt to propose an underlying pathogenesis model and a flow chart for diagnosing normoalbuminuric phenotype.

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“…The clinical courses of kidney diseases in patients with diabetes have become heterogeneous and different from the typical course of diabetic nephropathy, possibly because of the widespread use of renin-angiotensin-aldosterone system inhibitors and the presence of multiple comorbid conditions. [2][3][4] Renal complications of diabetes are now referred to as "diabetic kidney disease," which includes various disease phenotypes, in contrast to the concept of typical diabetic nephropathy. 5 Since this paradigm shift around 2014, many nephrologists have actively performed PRBs for patients with diabetes and pointed out its effectiveness in the diagnosis and treatment of renal complications of diabetes.…”

Section: Introductionmentioning

confidence: 99%

Association Between Diabetes and Major Bleeding Complications of Renal Biopsy

Hasegawa

Okada

Aso

et al. 2022

Kidney International Reports

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Arteriolar Hyalinosis Predicts Increase in Albuminuria and GFR Decline in Normo- and Microalbuminuric Japanese Patients With Type 2 Diabetes

Abstract: Arteriolar hyalinosis is an additional histological predictor for albuminuria increase and GFR decline in normo- and microalbuminuric Japanese people with type 2 diabetes.

Cited by 28 publications

References 26 publications

Changes in Albuminuria But Not GFR are Associated with Early Changes in Kidney Structure in Type 2 Diabetes

Changes in Albuminuria But Not GFR are Associated with Early Changes in Kidney Structure in Type 2 Diabetes

Update on pathogenesis and diagnosis flow of normoalbuminuric diabetes with renal insufficiency

Association Between Diabetes and Major Bleeding Complications of Renal Biopsy

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