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Arteriolar Hyalinosis Predicts Increase in Albuminuria and GFR Decline in Normo- and Microalbuminuric Japanese Patients With Type 2 Diabetes
Diabetes Care ( IF 16.2 ) Pub Date : 2017-08-03 , DOI: 10.2337/dc17-0209
Tatsumi Moriya 1 , Kazuki Omura 2 , Madoka Matsubara 1 , Yuki Yoshida 1 , Kei Hayama 1 , Motoshi Ouchi 3
Affiliation  

OBJECTIVE This study investigated the association between renal histology, as assessed by morphometric analysis using light (LM) and electron (EM) microscopy, and changes in urinary albumin excretion (UAE) and glomerular filtration rate (GFR) in Japanese people with type 2 diabetes in the early stages of diabetic nephropathy.

RESEARCH DESIGN AND METHODS We performed percutaneous renal biopsies in 29 patients with type 2 diabetes (22 men, mean ± SD age 49 ± 10 years and GFR 119 ± 27 mL/min/1.73 m2, with 15 normoalbuminuric [UAE <20 μg/min], and 14 microalbuminuric [UAE 20–200 μg/min]) to clarify which histological factors were associated with changes in UAE and GFR during 8.0 ± 3.5 years’ follow-up. Glomerular structural changes including mesangial volume fraction [Vv(Mes/glom)] were estimated using EM, whereas the index of arteriolar hyalinosis (IAH) score was assessed by LM. Patients underwent annual measurement of GFR using iohexol injection with simultaneous urine collections for UAE.

RESULTS Vv(Mes/glom) was negatively correlated with baseline and follow-up GFR but not with UAE. The IAH score was positively correlated with UAE and negatively correlated with GFR at follow-up, but it was not correlated with either UAE or GFR at baseline. GFR at follow-up was significantly decreased from baseline in patients with IAH scores ≥2.0 and significantly lower than in patients with IAH scores <2.0. Patients with IAH scores <2.0 showed no significant change in GFR during follow-up.

CONCLUSIONS Arteriolar hyalinosis is an additional histological predictor for albuminuria increase and GFR decline in normo- and microalbuminuric Japanese people with type 2 diabetes.



中文翻译:

小动脉透明质酸预测正常和微量白蛋白尿的日本2型糖尿病患者蛋白尿增加和GFR下降

目的本研究调查了日本2型糖尿病患者肾脏组织学(通过使用光(LM)和电子(EM)显微镜进行形态计量学分析评估)与尿白蛋白排泄(UAE)和肾小球滤过率(GFR)变化之间的关联在糖尿病肾病的早期。

研究设计和方法我们对29位2型糖尿病患者(22名男性,平均±SD年龄49±10岁,GFR 119±27 mL / min / 1.73 m 2)和15名正常白蛋白尿[UAE <20μg/ min]和14种微白蛋白尿[UAE 20–200μg/ min]),以阐明在8.0±3.5年的随访期间哪些组织学因素与UAE和GFR的变化有关。肾小球结构变化,包括肾小球系膜体积分数[Vv(Mes / glom)]使用EM进行评估,而小动脉透明质酸(IAH)指数则通过LM进行评估。患者使用碘海醇注射液同时对阿联酋进行尿液收集,对GFR进行年度测量。

结果Vv(Mes / glom)与基线和随访GFR呈负相关,而与阿联酋则不相关。随访时,IAH评分与阿联酋呈正相关,与GFR呈负相关,但在基线时与IAE或GFR均不相关。IAH评分≥2.0的患者随访时的GFR较基线显着降低,而IAH评分<2.0的患者则明显低于基线。IAH评分<2.0的患者在随访期间显示GFR无明显变化。

结论小动脉透明质酸是日本2型糖尿病正常和微量白蛋白尿患者白蛋白尿增加和GFR下降的另一组织学预测因子。

更新日期:2017-09-08
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