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Abstract: FR-PO467

Histological Findings Associated with Proteinuria in Diabetic Nephropathy

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Eriguchi, Masahiro, Nara Medical University, Kashihara, NARA, Japan
  • Matsui, Masaru, Nara Prefecture General Medical Center, Nara, Nara, Japan
  • Tagawa, Miho, Nara Medical University, Kashihara, NARA, Japan
  • Samejima, Ken-ichi, First Department of Internal Medicine, Nara Medical University, KASHIHARA, Japan
  • Tsuruya, Kazuhiko, Nara Medical University, Kashihara, NARA, Japan
  • Morimoto, Katsuhiko, Nara Prefecture Western Medical Center, Ikoma-gun, Nara, Japan
  • Nishimoto, Masatoshi, Nara Medical University, Kashihara, NARA, Japan
Background

Regardless of the causes of renal diseases, proteinuria is the strongest predictor of renal prognosis among clinical parameters. Diabetic kidney disease (DKD) patients are rarely examined by renal biopsy. Determination of the histological lesions that are responsible for proteinuria in DKD will be useful for the future research to identify the intervention to the specific lesions.

Methods

This is a serial cross-sectional study of 347 adults with biopsy-proven diabetic nephropathy (DN) from 1981 to 2014. Predictors were histological findings in renal pathology and outcome variable was proteinuria. DN was evaluated by two renal pathologists according to 9 glomerular lesions; mesangial expansion, exudative lesion, nodular sclerosis, microaneurysm, duplication of the basement membrane, perihilar neovascularization, glomerulomegaly, global sclerosis, and segmental sclerosis, 2 tubulointerstitial lesions; interstitial fibrosis tubular atrophy (IFTA) and inflammatory cell infiltration, and 2 vascular lesions; arteriolar hyalinosis and intimal thickening of large artery. In addition to histological findings, age, sex, body mass index, estimated glomerular filtration rate (eGFR), systolic blood pressure and use of renin-angiotensin system blockers were used for adjustment. Statistical analyses were performed using multivariate general linear model and two-way analyses of covariate and variance.

Results

Hypertension and diabetic retinopathy were observed in 65% and 46% of patients, respectively, with mean age of 58 ± 11. Median level of proteinuria at the time of renal biopsy was 0.50 g/day (25th and 75th percentile: 0.20 and 2.7 g/day) and mean eGFR was 62.4 ± 32.6 mL/min/1.73m2. Twelve out of thirteen histological lesions were significantly correlated with each other and proteinuria levels. However, after multivariate adjustment nodular sclerosis and IFTA remained significant predictors for proteinuria levels. Two-way analyses of covariate and variance showed that IFTA and glomerular lesions had a synergetic effect on increased multivariate adjusted proteinuria levels.

Conclusion

Nodular sclerosis and IFTA were significant predictors of proteinuria levels and had a synergetic effect on increased proteinuria in DN patients. These two lesions might be relevant targets for developing new therapy in DKD patients.

Funding

  • Government Support - Non-U.S.