Rapid progression of diabetic nephropathy is linked to inflammation and episodes of acute renal failure

Am J Nephrol. 2010;32(5):469-75. doi: 10.1159/000320749. Epub 2010 Oct 19.


Background/aims: Chronic kidney disease (CKD) from diabetic nephropathy is characterized by progressive loss of renal function. The renal decline has been viewed as a linear fall, presumably dependent on metabolic, hemodynamic and dietary stresses. However, renal injury in diabetic nephropathy can be rapidly aggravated by unpredictable external and internal factors, a state of affairs inconsistent with a linear loss of function. Acute renal injury and subsequent inflammation are potential factors, and we investigated their presence in renal biopsies from patients with nephropathy.

Methods: In a protocol approved by the Indiana University School of Medicine Institutional Review Board, renal biopsy specimens, estimated GFR, proteinuria and renal survival were examined in patients with diabetic nephropathy.

Results: Prominent clusters of inflammatory cells, particularly macrophages, were detected in the renal biopsy specimens. CKD progressed rapidly but not linearly, in that CKD was characterized by a succession of seemingly random episodes of self-limited acute renal failure. Episodes of acute kidney injury were associated with progression to end-stage renal disease.

Conclusions: We propose that diabetic nephropathy is complicated by unpredictable and possibly random episodes of usually self-limited acute renal failure, and by subsequent renal inflammation, which appear to accelerate progression and eventual kidney loss.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acute Kidney Injury / complications*
  • Acute Kidney Injury / pathology
  • Biopsy
  • Diabetic Neuropathies / complications*
  • Diabetic Neuropathies / pathology
  • Disease Progression
  • Fibrosis / pathology
  • Glomerular Filtration Rate
  • Humans
  • Inflammation / complications*
  • Inflammation / pathology
  • Kidney / pathology
  • Kidney Failure, Chronic / etiology*
  • Middle Aged