Kidney Week

Abstract: TH-PO745

Comparison of Clinicopathological Features of Biopsy-Proven Diabetic Nephropathy between CKD Heat Map Classification and the Japanese Classification of Diabetic Nephropathy

Session Information

• Diabetic and Obesity Induced Kidney Disease - Clinical - I
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Diabetes

• 502 Diabetes Mellitus and Obesity: Clinical

Authors

• Furuichi, Kengo, Division of Nephrology, Kanazawa University Hospital, Kanazawa, ISHIKAWA, Japan

Kengo Furuichi,

• Shimizu, Miho, Division of Nephrology, Kanazawa University Hospital, Kanazawa, ISHIKAWA, Japan

Miho Shimizu,

• Toyama, Tadashi, Division of Nephrology, Kanazawa University Hospital, Kanazawa, ISHIKAWA, Japan

Tadashi Toyama,

• Iwata, Yasunori, Division of Nephrology, Kanazawa University Hospital, Kanazawa, ISHIKAWA, Japan

Yasunori Iwata,

• Sakai, Norihiko, Division of Nephrology, Kanazawa University Hospital, Kanazawa, ISHIKAWA, Japan

Norihiko Sakai,

• Wada, Takashi, Kanazawa University, Kanazawa, Japan

Takashi Wada,

Background

CKD heat map classification and the Japanese classification of diabetic nephropathy reflects the risks of mortality, cardiovascular events and kidney prognosis and is clinically useful. Furthermore, pathological findings of diabetic nephropathy are also known to be useful for predicting prognoses. In this study, we evaluated the characteristics of clinicopathological features between the two clinical classification of diabetic nephropathy.

Methods

The clinical data of 600 biopsy-confirmed diabetic nephropathy patients were collected retrospectively from 13 centres across Japan. Pthologica features and decreasing rate of estimated GFR (eGFR) were evaluated, and compared between CKD heat map classification and the Japanese classification of diabetic nephropathy.

Results

The median observation period was 70.4 (IQR; 20.9-101.0) months. Each stage had specific characteristic pathological features. Diffuse lesions, interstitial fibrosis and/or tubular atrophy (IFTA), interstitial cell infiltration, arteriolar hyalinosis and atherosclerosis were detected in more than half the cases, even in Green and Yellow in CKD heat map and Stage 1 in the Japanese classification of diabetic nephropathy. Median declining speed of eGFR in all cases was 5.61 mL/min/1.73m²/year, and the median rate of declining kidney function within 2 years after kidney biopsy was 24.0%. Declining rate of eGFR within 2 years after kidney biopsy increased as CKD heat map classification and the stage of Japanese classification of diabetic nephropathy increased; and Green and Yellow, Orange, Red; 3.7, 17.9, 34.3 %, respectively, Stage 1, 2, 3, 4; -0.9, 10.7, 26.5, 38.8 %, respectively. Sensitivity of 30% reduction of the eGFR in two years as a surrogate end point of kidney death was 56.7% (Green and Yellow, Orange, Red; 0, 80.0, 56.5 %, and Stage 1, 2, 3, 4; 0, 0, 84.2, 11.1 %, respectively).

Conclusion

This study indicated that there were characteristic pathological features in each clinical classification. Moreover, decreasing rate of eGFR increased in advanced stages of diabetic nephropathy, and sensitivity of surrogate end point (30% reduction of the eGFR in two years) was relatively high in Stage 3 Japanese classification of diabetic nephropathy, and Orange in CKD heat map.