Abstract: SA-PO536
Implications of Solidified Glomerulosclerosis and Extracapillary Hypercellularity in Chinese Patients with Type 2 Diabetes and Diabetic Nephropathy
Session Information
- Diabetic Kidney Disease: Pathology, Epidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Zhao, Lijun, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China, Chengdu, China
- Liu, Fang, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China, Chengdu, China
- Li, Lin, Division of Pathology, West China Hospital of Sichuan University, Chengdu, China
Background
This study was aimed to determine nephropathologic markers for time to end-stage renal disease (ESRD) in Chinese patients with type 2 diabetes and diabetic nephropathy (DN).
Methods
This retrospective cohort study recruited 322 Chinese type 2 diabetic patients from 2003 to 2017 with biopsy-proven diabetic nephropathy who received follow-up over 12months. All kidney biopsy specimens were fully assessed under a uniform scale. Competing risk models with death as the competing risk was used to estimate the sub-distribution hazard ratios (SHRs) for ESRD.
Results
During a median follow up of 26.0 months, 144 (44.7%) patients progressed to ESRD and 17 (5.3%) patients died before entering ESRD. Global glomerulosclerosis was further separated into three categories: solidified glomerulosclerosis (Figure 1 A-B), ischemic obsolescent glomerulosclerosis (Figure 1 C-D) and not otherwise specified glomerulosclerosis (Figure 1 E-H). Pathological parameters in Renal Pathology Society system were associated with ESRD in univariate analysis but failed to predict ESRD in multivariable models. After adjusting for parameters of demographics, baseline kidney functions, nutritional status, and medications in the multivariable model, solidified glomerulosclerosis and extracapillary hypercellularity (SHR, 1.77; 95% CI, 1.11-2.80; and SHR, 2.48; 95% CI, 1.58-3.90, respectively) were identified as risk factors for ESRD. Moreover, patients in RPS class III with a higher proportion of solidified glomerulosclerosis had a lower 5-year renal survival rate than class IV.
Conclusion
In Chinese type 2 diabetic patients with DN, solidified glomerulosclerosis and EXHC were prognostic indicators for ESRD. Solidified glomerulosclerosis contributed partly to the worse renal outcome of patients in class III.
A-B, Solidified glomerulosclerosis. C-D, Ischemia obsolescent glomerulosclerosis. E-F, One type of not otherwise specified glomerulosclerosis. G-H, Another type of not otherwise specified glomerulosclerosis. Bar= 50 µm.
Funding
- Government Support - Non-U.S.