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Abstract: SA-PO533

Clinicopathological Features of a Rapid Decliner in Diabetic Nephropathy

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Furuichi, Kengo, Kanazawa Medical University, Kahoku-Gun, Japan
  • Shimizu, Miho, Kanazawa University, Ishikawa, Japan
  • Toyama, Tadashi, Kanazawa University, Ishikawa, Japan
  • Yokoyama, Hitoshi, Kanazawa University, Ishikawa, Japan
  • Wada, Takashi, Kanazawa University, Ishikawa, Japan
Background

Declining speed of kidney function in diabetic nephropathy is different in each case. It is well known that there are characteristic groups; “rapid decliner” and “no or slow decliner”. Although, many studies of kidney prognosis and cardiovascular events in cases of diabetic nephropathy have been reported, clinical and pathological features of these groups are unclear so far.

Methods

Biopsy proven 600 diabetic nephropathy cases were enrolled in this study. Among them, 385 cases were able to calculate the eGTR decline speed 3 years after kidney biopsy. The cases were classified into 4 groups in accordance with the eGFR declining speed. The first quartile, that is the fastest declining speed group, contains 97 cases, and the fourth quartile, that is the slowest declining speed group, contains 96 cases. Clinical data and kidney biopsy data of these two groups were evaluated. The pathological findings (Nine glomerular lesions, two interstitial lesions, and two vascular lesions) were followed by the previous paper (Nephrol Dial Transplant. 2018;33:138-148).

Results

Declining speed op the first quartile group (rapid declining) was 13.9 mL / min / 1.73 m 2 / year or more (median 21.3), and that of the fourth quartile (slow declining) group was 1.9 mL / min / 1.73 m 2 / year or less (median -1.96). The incidence of renal composite events and renal deaths, 40.0 and 4.6 (100 persons / year) in the first quartile, and 3.12 and 0.5 in the fourth quartile, respectively.
In background analysis at biopsy, ten pathological factors and three clinical factors were statistically difference between two groups. Using multivariate logistic analysis showed that three pathological factors (nodular lesion, mesangiolysis, and polar vasculosis) and one clinical factor (urinary albumin) were statistically significant, and odds ratio of these factors were 4.4 , 3.0, 6.9 and 4.0, respectively. We evaluate the cohort with tertile, in the same way of the quartile as the tertile. The result of tertile analysis an almost similar to the results of quartile.

Conclusion

Through this analysis, large amounts of urinary albuminuria, and three pathological findings (nodular lesion, mesangiolysis, and polar vasculosis) were characteristic features of patients with rapid kidney function declining.

Funding

  • Government Support - Non-U.S.