Histological predictors for renal prognosis in diabetic nephropathy in diabetes mellitus type 2 patients with overt proteinuria

Nephrology (Carlton). 2012 Jan;17(1):68-75. doi: 10.1111/j.1440-1797.2011.01525.x.


Aim: Although several clinical risk factors for end-stage renal disease in diabetic nephropathy are known, the pathological findings that may help predict renal prognosis have not yet been defined.

Methods: We enrolled 69 diabetes mellitus type 2 patients with overt proteinuria and biopsy-confirmed diabetic nephropathy with mesangial expansion, and retrospectively examined the association of histological and clinical findings with renal outcome. The median follow-up duration was 52 months. Histological scoring was made according to that of Tervaert et al. Patients were divided into four groups according to glomerular classification (class 2a, mild mesangial expansion, n=11; class 2b, severe mesangial expansion without nodular sclerosis, n=15; class 3, nodular sclerosis, n=36; class 4, global glomerulosclerosis observed in more than 50% of glomeruli, n=7). Interstitial and vascular lesions were scored for each patient. A renal event was defined as a condition requiring the initiation of chronic dialysis or doubling of the serum creatinine level.

Results: Cox proportional hazard analysis showed that the glomerular classes were not significant variables, while interstitial fibrosis, tubular atrophy and interstitial inflammation were independent variables associated with renal end-point (HR: 3.36 (95% confidence interval: 1.21-9.32), 4.74 (1.26-17.91)). There were no significant differences in the renal survival rates between the glomerular classes 2a and 2b combined group and the glomerular class 3 group (P=0.17, log-rank test).

Conclusion: Interstitial lesions but not glomerular lesions were a significant predictor for renal prognosis in diabetic nephropathy in type 2 diabetes patients with overt proteinuria.

MeSH terms

  • Aged
  • Biopsy / methods
  • Biopsy / statistics & numerical data
  • Diabetes Mellitus, Type 2 / complications
  • Diabetic Nephropathies / complications
  • Diabetic Nephropathies / pathology*
  • Diabetic Nephropathies / physiopathology
  • Diabetic Nephropathies / therapy
  • Female
  • Glomerular Mesangium / pathology*
  • Glomerular Mesangium / physiopathology
  • Histological Techniques*
  • Humans
  • Kidney Function Tests
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Proteinuria* / etiology
  • Proteinuria* / pathology
  • Renal Dialysis
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Survival Rate