The Morphologic Patterns of Diabetic Nephropathy in Koreans
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Background : Diabetic nephropathy is the most common cause of end-stage renal disease and it has various pathologic features. We investigated the clinicopathologic differences between the histologic classes of diabetic nephropathy. Methods : A total of 46 patients with diabetic nephropathy were evaluated. Morphologically, the renal lesions were divided into three categories: class 1, diffuse or nodular glomerulosclerosis: class 2, vascular change without evidence of glomerulosclerosis: and class 3, non-diabetic renal disease superimposed on diabetic glomerulosclerosis. We evaluated the laboratory findings and the histologic findings, including mesangial expansion, interstitial fibrosis and inflammation, arteriolar hyalinosis and tubular atrophy. Results : The proportion of each class was 32 cases (70%), 4 cases (9%) and 10 cases (21%), respectively. The clinical and laboratory data showed no significant difference among the classes. For the groups of class 1, the group with nodular sclerosis showed a higher serum creatinine level than did the diffuse group (p=0.003). IgA nephropathy was the most common nondiabetic renal disease superimposed on diabetic glomerulosclerosis in our study. Conclusions : The patients with nodular glomerulosclerosis presented with a more progressed clinicopathological features than did the patients with class 1 diffuse glomerulosclerosis. We also found 21% of all the patients with diabetic nephropathy had superimposed non-diabetic renal disease in a Korean population.
Abstract
Background : Diabetic nephropathy is the most common cause of end-stage renal disease and it has various pathologic features. We investigated the clinicopathologic differences between the histologic classes of diabetic nephropathy. Methods : A total of 46 patients with diabetic nephropathy were evaluated. Morphologically, the renal lesions were divided into three categories: class 1, diffuse or nodular glomerulosclerosis: class 2, vascular change without evidence of glomerulosclerosis: and class 3, non-diabetic renal disease superimposed on diabetic glomerulosclerosis. We evaluated the laboratory findings and the histologic findings, including mesangial expansion, interstitial fibrosis and inflammation, arteriolar hyalinosis and tubular atrophy. Results : The proportion of each class was 32 cases (70%), 4 cases (9%) and 10 cases (21%), respectively. The clinical and laboratory data showed no significant difference among the classes. For the groups of class 1, the group with nodular sclerosis showed a higher serum creatinine level than did the diffuse group (p=0.003). IgA nephropathy was the most common nondiabetic renal disease superimposed on diabetic glomerulosclerosis in our study. Conclusions : The patients with nodular glomerulosclerosis presented with a more progressed clinicopathological features than did the patients with class 1 diffuse glomerulosclerosis. We also found 21% of all the patients with diabetic nephropathy had superimposed non-diabetic renal disease in a Korean population.
참고문헌 (22)
- Hong D, "Nodular glomerular lesion: a later stage of diabetic nephropathy?", Diabetes Res Clin Pract, 78, pp.189~195 (2007)
- Gross JL, "Diabetic nephropathy: diagnosis, prevention, and treatment", Diabetes Care, 28, pp.164~176 (2005)
- Wong TY, "Renal outcome in type 2 diabetic patients with or without coexisting nondiabetic nephropathies", Diabetes Care, 25, pp.900~905 (2002)
- Mazzucco G, "Different patterns of renal damage in type 2 diabetes mellitus: a multicentric study on 393 biopsies", Am J Kidney Dis, 39, pp.713~720 (2002)
- Lee EY, "Non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus", Yonsei Med J, 40, pp.321~326 (1999)
- Gambara V, "Heterogeneous nature of renal lesions in type II diabetes", J Am Soc Nephrol, 3, pp.1458~1466 (1993)
- Monga G, "Pattern of double glomerulopathies. A clinicopathologic study in nine nondiabetic patients", Nephron, 56, pp.73~80 (1990)
- Amoah E, "Clinical identification of nondiabetic renal disease in diabetic patients with type I and type II disease presenting with renal dysfunction", Am J Nephrol, 8, pp.204~211 (1988)
- Parving HH, "Prevalence and causes of albuminuria in non-insulin-dependent diabetic patients", Kidney Int, 41, pp.758~762 (1992)
- Kleinknecht D, "Increased prevalence of non-diabetic renal pathology in type II diabetes mellitus", Nephrol Dial Transplant, 7, pp.1258~1259 (1992)
- Richards NT, "Increased prevalence of renal biopsy findings other than diabetic glomerulopathy in type II diabetes mellitus", Nephrol Dial Transplant, 7, pp.397~399 (1992)
- Suzuki Y, "A light microscopic study of glomerulosclerosis in Japanese patients with noninsulin-dependent diabetes mellitus: the relationship between clinical and histological features", Clin Nephrol, 42, pp.155~162 (1994)
- John GT, "Nondiabetic renal disease in noninsulin-dependent diabetics in a south Indian Hospital", Nephron, 67, pp.441~443 (1994)
- Olsen S, "How often is NIDDM complicated with nondiabetic renal disease? An analysis of renal biopsies and the literature", Diabetologia, 39, pp.1638~1645 (1996)
- Mak SK, "Clinical predictors of non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus", Nephrol Dial Transplant, 12, pp.2588~2591 (1997)
- Wirta O, "Renal findings and glomerular pathology in diabetic subjects", Nephron, 84, pp.236~242 (2000)
- Schwartz MM, "Renal pathology patterns in type II diabetes mellitus: relationship with retinopathy. The Collaborative Study Group", Nephrol Dial Transplant, 13, pp.2547~2552 (1998)
- Murussi M, "Risk factors for microalbuminuria and macroalbuminuria in type 2 diabetic patients: a 9-year follow-up study", Diabetes Care, 25, pp.1101~1103 (2002)
- Gall MA, "Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study", BMJ, 314, pp.783~788 (1997)
- Paik SS, "Immunohistochemical localization of extracellular matrix components in diabetic nephropathy", Korean J Pathol, 31, pp.427~435 (1997)
- Alsaad KO, "Distinguishing diabetic nephropathy from other causes of glomerulosclerosis: an update", J Clin Pathol, 60, pp.18~26 (2007)
- Lai FM, "Diabetic patients with IgA nephropathy and diabetic glomerulosclerosis", Mod Pathol, 6, pp.684~690 (1993)