Kidney Week

Abstract: PO0957

Association of Renal Pathological Lesions and Renal Prognosis in Patients with Diabetic Nephropathy and Effect Modification by Proteinuria

Session Information

• Diabetic Kidney Disease: Clinical - 1
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Fukata, Fumihiro, Nara Medical University, Kashihara, Japan

Fumihiro Fukata,

• Eriguchi, Masahiro, Nara Medical University, Kashihara, Japan

Masahiro Eriguchi,

• Tasaki, Hikari, Nara Medical University, Kashihara, Japan

Hikari Tasaki,

• Furuyama, Riri, Nara Medical University, Kashihara, Japan

Riri Furuyama,

• Nishimoto, Masatoshi, Nara Medical University, Kashihara, Japan

Masatoshi Nishimoto,

• Kosugi, Takaaki, Nara Medical University, Kashihara, Japan

Takaaki Kosugi,

• Tanabe, Kaori, Nara Medical University, Kashihara, Japan

Kaori Tanabe,

• Morimoto, Katsuhiko, Nara Prefecture Seiwa Medical Center, Ikoma-gun, Japan

Katsuhiko Morimoto,

• Matsui, Masaru, Nara Prefecture General Medical Center, Nara, Japan

Masaru Matsui,

• Samejima, Ken-ichi, Nara Medical University, Kashihara, Japan

Ken-ichi Samejima,

• Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Japan

Kazuhiko Tsuruya,

Background

There are few detailed studies on renal pathological findings in diabetic nephropathy (DN) with low urinary protein (UP). We examined whether the association of renal histology with renal prognosis was modified by UP levels in DN diagnosed by renal biopsy.

Methods

The total of 396 participants diagnosed with DN by renal biopsy were divided into 2 groups by the level of UP; ≥0.5 g/day (high-UP group, n = 197) or <0.5 g/day (low-UP group, n = 199). The association of glomerular lesion (GL) and interstitial/tubular lesion (IFTA) with incidence of end-stage kidney disease (ESKD) was examined using Cox proportional hazard model with the adjustment for confounding factors in each proteinuria group.

Results

Compared to high-UP group, low-UP group had a higher eGFR (median [interquartile range (IQR)]: 66 [48, 89] mL/min/1.73m² vs 49 [31, 70], p <0.001), lower systolic blood pressure (128 [112, 140] mmHg vs 140 [126, 154], p <0.001), lower prevalence of severe GL (6.1% vs 56.8%, p <0.001) and IFTA (12.2% vs 61.3%, p <0.001). During a median [IQR] observation period of 8.3 [3.9, 17.6] years, 14 and 78 patients reached ESKD in low-UP and high-UP groups, respectively. Cox hazard model adjusted for confounding factors showed that both GL and IFTA were significantly associated with renal prognosis in the high-UP group, whereas only IFTA showed significant association in the low-UP group. The association of IFTA with renal prognosis was consistent (p for interaction = 0.45), but that of GL was significantly different between the two groups (p for interaction <0.01).

Conclusion

IFTA is consistently associated with renal prognosis regardless of UP levels, but GL is associated with renal prognosis only in patients with overt UP.