Glomerular structural-functional relationship models of diabetic nephropathy are robust in type 1 diabetic patients

Michael Mauer, Maria Luiza Caramori, Paola Fioretto, Behzad Najafian

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34 Scopus citations


Studies of structural-functional relationships have improved understanding of the natural history of diabetic nephropathy (DN). However, in order to consider structural end points for clinical trials, the robustness of the resultant models needs to be verified. This study examined whether structural-functional relationship models derived from a large cohort of type 1 diabetic (T1D) patients with a wide range of renal function are robust. The predictability of models derived from multiple regression analysis and piecewise linear regression analysis was also compared. T1D patients (n = 161) with research renal biopsies were divided into two equal groups matched for albumin excretion rate (AER). Models to explain AER and glomerular filtration rate (GFR) by classical DN lesions in one group (T1D-model, or T1D-M) were applied to the other group (T1D-test, or T1D-T) and regression analyses were performed. T1D-M-derived models explained 70 and 63% of AER variance and 32 and 21% of GFR variance in T1D-M and T1D-T, respectively, supporting the substantial robustness of the models. Piecewise linear regression analyses substantially improved predictability of the models with 83% of AER variance and 66% of GFR variance explained by classical DN glomerular lesions alone. These studies demonstrate that DN structural-functional relationship models are robust, and if appropriate models are used, glomerular lesions alone explain a major proportion of AER and GFR variance in T1D patients.

Original languageEnglish (US)
Pages (from-to)918-923
Number of pages6
JournalNephrology Dialysis Transplantation
Issue number6
StatePublished - Jun 1 2015

Bibliographical note

Publisher Copyright:
© The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.


  • AER
  • GFR
  • diabetic nephropathy
  • piecewise linear regression
  • renal biopsy


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