Patterns of renal injury in NIDDM patients with microalbuminuria

P. Fioretto, Michael Mauer, E. Brocco, M. Velussi, F. Frigato, B. Muollo, M. Sambataro, C. Abaterusso, B. Baggio, G. Crepaldi, R. Nosadini

Research output: Contribution to journalArticle

317 Citations (Scopus)

Abstract

Microalbuminuria predicts overt nephropathy in non-insulin-dependent diabetic (NIDDM) patients; however, the structural basis for this functional abnormality is unknown. In this study we evaluated renal structure and function in a cohort of 34 unselected microalbuminuric NIDDM patients (26 male/8 female, age: 58 ± 7 years, known diabetes duration: 11 ± 6 years, HbA(1c): 8.5 ± 1.6%). Systemic hypertension was present in all but 3. Glomerular filtration rate (GFR) was 101 ± 27 ml · min-1 · 1.73 m-2 and albumin excretion rate (AER) 44 (20-199) μg/min. Light microscopic slides were categorized as: C I) normal or near normal renal structure; C II) changes 'typical' of diabetic nephropathology in insulin-dependent diabetes (IDDM) (glomerular, tubulo-interstitial and arteriolar changes occurring in parallel); C III) 'atypical' patterns of injury, with absent or only mild diabetic glomerular changes associated with disproportionately severe renal structural changes including: important tubulo-interstitial with or without arteriolar hyalinosis with or without global glomerular sclerosis. Ten patients (29.4%) were classified as C I, 10 as C II (29.4%) and 14 as C III (41.2%); none of these patients had any definable non-diabetic renal disease. GFR, AER and blood pressure were similar in the three groups, while HbA(1c) was higher in C II and C III than in C I patients. Diabetic retinopathy was present in all C II patients (background in 50% and proliferative in 50%). None of the patients in C I and C III had proliferative retinopathy, while background retinopathy was observed in 50% of C I and 57% of C III patients. In summary, microalbuminuric NIDDM patients are structurally heterogeneous with less than one third having 'typical' diabetic nephropathology. The presence of both 'typical' and 'atypical' patterns of renal pathology was associated with worse metabolic control, suggesting that hyperglycaemia may cause different patterns of renal injury in older NIDDM compared to younger IDDM patients.

Original languageEnglish (US)
Pages (from-to)1569-1576
Number of pages8
JournalDiabetologia
Volume39
Issue number12
DOIs
StatePublished - Dec 9 1996

Fingerprint

Type 2 Diabetes Mellitus
Kidney
Wounds and Injuries
Glomerular Filtration Rate
Type 1 Diabetes Mellitus
Albumins
Sclerosis
Diabetic Retinopathy
Hyperglycemia
Insulin
Pathology
Blood Pressure
Hypertension
Light

Keywords

  • NIDDM
  • glomerular filtration rats
  • microalbuminuria
  • renal structure

Cite this

Fioretto, P., Mauer, M., Brocco, E., Velussi, M., Frigato, F., Muollo, B., ... Nosadini, R. (1996). Patterns of renal injury in NIDDM patients with microalbuminuria. Diabetologia, 39(12), 1569-1576. https://doi.org/10.1007/s001250050616

Patterns of renal injury in NIDDM patients with microalbuminuria. / Fioretto, P.; Mauer, Michael; Brocco, E.; Velussi, M.; Frigato, F.; Muollo, B.; Sambataro, M.; Abaterusso, C.; Baggio, B.; Crepaldi, G.; Nosadini, R.

In: Diabetologia, Vol. 39, No. 12, 09.12.1996, p. 1569-1576.

Research output: Contribution to journalArticle

Fioretto, P, Mauer, M, Brocco, E, Velussi, M, Frigato, F, Muollo, B, Sambataro, M, Abaterusso, C, Baggio, B, Crepaldi, G & Nosadini, R 1996, 'Patterns of renal injury in NIDDM patients with microalbuminuria', Diabetologia, vol. 39, no. 12, pp. 1569-1576. https://doi.org/10.1007/s001250050616
Fioretto P, Mauer M, Brocco E, Velussi M, Frigato F, Muollo B et al. Patterns of renal injury in NIDDM patients with microalbuminuria. Diabetologia. 1996 Dec 9;39(12):1569-1576. https://doi.org/10.1007/s001250050616
Fioretto, P. ; Mauer, Michael ; Brocco, E. ; Velussi, M. ; Frigato, F. ; Muollo, B. ; Sambataro, M. ; Abaterusso, C. ; Baggio, B. ; Crepaldi, G. ; Nosadini, R. / Patterns of renal injury in NIDDM patients with microalbuminuria. In: Diabetologia. 1996 ; Vol. 39, No. 12. pp. 1569-1576.
@article{b25f15249cf643af9a8f282f9b882ad6,
title = "Patterns of renal injury in NIDDM patients with microalbuminuria",
abstract = "Microalbuminuria predicts overt nephropathy in non-insulin-dependent diabetic (NIDDM) patients; however, the structural basis for this functional abnormality is unknown. In this study we evaluated renal structure and function in a cohort of 34 unselected microalbuminuric NIDDM patients (26 male/8 female, age: 58 ± 7 years, known diabetes duration: 11 ± 6 years, HbA(1c): 8.5 ± 1.6{\%}). Systemic hypertension was present in all but 3. Glomerular filtration rate (GFR) was 101 ± 27 ml · min-1 · 1.73 m-2 and albumin excretion rate (AER) 44 (20-199) μg/min. Light microscopic slides were categorized as: C I) normal or near normal renal structure; C II) changes 'typical' of diabetic nephropathology in insulin-dependent diabetes (IDDM) (glomerular, tubulo-interstitial and arteriolar changes occurring in parallel); C III) 'atypical' patterns of injury, with absent or only mild diabetic glomerular changes associated with disproportionately severe renal structural changes including: important tubulo-interstitial with or without arteriolar hyalinosis with or without global glomerular sclerosis. Ten patients (29.4{\%}) were classified as C I, 10 as C II (29.4{\%}) and 14 as C III (41.2{\%}); none of these patients had any definable non-diabetic renal disease. GFR, AER and blood pressure were similar in the three groups, while HbA(1c) was higher in C II and C III than in C I patients. Diabetic retinopathy was present in all C II patients (background in 50{\%} and proliferative in 50{\%}). None of the patients in C I and C III had proliferative retinopathy, while background retinopathy was observed in 50{\%} of C I and 57{\%} of C III patients. In summary, microalbuminuric NIDDM patients are structurally heterogeneous with less than one third having 'typical' diabetic nephropathology. The presence of both 'typical' and 'atypical' patterns of renal pathology was associated with worse metabolic control, suggesting that hyperglycaemia may cause different patterns of renal injury in older NIDDM compared to younger IDDM patients.",
keywords = "NIDDM, glomerular filtration rats, microalbuminuria, renal structure",
author = "P. Fioretto and Michael Mauer and E. Brocco and M. Velussi and F. Frigato and B. Muollo and M. Sambataro and C. Abaterusso and B. Baggio and G. Crepaldi and R. Nosadini",
year = "1996",
month = "12",
day = "9",
doi = "10.1007/s001250050616",
language = "English (US)",
volume = "39",
pages = "1569--1576",
journal = "Diabetologia",
issn = "0012-186X",
publisher = "Springer Verlag",
number = "12",

}

TY - JOUR

T1 - Patterns of renal injury in NIDDM patients with microalbuminuria

AU - Fioretto, P.

AU - Mauer, Michael

AU - Brocco, E.

AU - Velussi, M.

AU - Frigato, F.

AU - Muollo, B.

AU - Sambataro, M.

AU - Abaterusso, C.

AU - Baggio, B.

AU - Crepaldi, G.

AU - Nosadini, R.

PY - 1996/12/9

Y1 - 1996/12/9

N2 - Microalbuminuria predicts overt nephropathy in non-insulin-dependent diabetic (NIDDM) patients; however, the structural basis for this functional abnormality is unknown. In this study we evaluated renal structure and function in a cohort of 34 unselected microalbuminuric NIDDM patients (26 male/8 female, age: 58 ± 7 years, known diabetes duration: 11 ± 6 years, HbA(1c): 8.5 ± 1.6%). Systemic hypertension was present in all but 3. Glomerular filtration rate (GFR) was 101 ± 27 ml · min-1 · 1.73 m-2 and albumin excretion rate (AER) 44 (20-199) μg/min. Light microscopic slides were categorized as: C I) normal or near normal renal structure; C II) changes 'typical' of diabetic nephropathology in insulin-dependent diabetes (IDDM) (glomerular, tubulo-interstitial and arteriolar changes occurring in parallel); C III) 'atypical' patterns of injury, with absent or only mild diabetic glomerular changes associated with disproportionately severe renal structural changes including: important tubulo-interstitial with or without arteriolar hyalinosis with or without global glomerular sclerosis. Ten patients (29.4%) were classified as C I, 10 as C II (29.4%) and 14 as C III (41.2%); none of these patients had any definable non-diabetic renal disease. GFR, AER and blood pressure were similar in the three groups, while HbA(1c) was higher in C II and C III than in C I patients. Diabetic retinopathy was present in all C II patients (background in 50% and proliferative in 50%). None of the patients in C I and C III had proliferative retinopathy, while background retinopathy was observed in 50% of C I and 57% of C III patients. In summary, microalbuminuric NIDDM patients are structurally heterogeneous with less than one third having 'typical' diabetic nephropathology. The presence of both 'typical' and 'atypical' patterns of renal pathology was associated with worse metabolic control, suggesting that hyperglycaemia may cause different patterns of renal injury in older NIDDM compared to younger IDDM patients.

AB - Microalbuminuria predicts overt nephropathy in non-insulin-dependent diabetic (NIDDM) patients; however, the structural basis for this functional abnormality is unknown. In this study we evaluated renal structure and function in a cohort of 34 unselected microalbuminuric NIDDM patients (26 male/8 female, age: 58 ± 7 years, known diabetes duration: 11 ± 6 years, HbA(1c): 8.5 ± 1.6%). Systemic hypertension was present in all but 3. Glomerular filtration rate (GFR) was 101 ± 27 ml · min-1 · 1.73 m-2 and albumin excretion rate (AER) 44 (20-199) μg/min. Light microscopic slides were categorized as: C I) normal or near normal renal structure; C II) changes 'typical' of diabetic nephropathology in insulin-dependent diabetes (IDDM) (glomerular, tubulo-interstitial and arteriolar changes occurring in parallel); C III) 'atypical' patterns of injury, with absent or only mild diabetic glomerular changes associated with disproportionately severe renal structural changes including: important tubulo-interstitial with or without arteriolar hyalinosis with or without global glomerular sclerosis. Ten patients (29.4%) were classified as C I, 10 as C II (29.4%) and 14 as C III (41.2%); none of these patients had any definable non-diabetic renal disease. GFR, AER and blood pressure were similar in the three groups, while HbA(1c) was higher in C II and C III than in C I patients. Diabetic retinopathy was present in all C II patients (background in 50% and proliferative in 50%). None of the patients in C I and C III had proliferative retinopathy, while background retinopathy was observed in 50% of C I and 57% of C III patients. In summary, microalbuminuric NIDDM patients are structurally heterogeneous with less than one third having 'typical' diabetic nephropathology. The presence of both 'typical' and 'atypical' patterns of renal pathology was associated with worse metabolic control, suggesting that hyperglycaemia may cause different patterns of renal injury in older NIDDM compared to younger IDDM patients.

KW - NIDDM

KW - glomerular filtration rats

KW - microalbuminuria

KW - renal structure

UR - http://www.scopus.com/inward/record.url?scp=10544247316&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=10544247316&partnerID=8YFLogxK

U2 - 10.1007/s001250050616

DO - 10.1007/s001250050616

M3 - Article

VL - 39

SP - 1569

EP - 1576

JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

IS - 12

ER -