Renal interstitial expansion in insulin-dependent diabetes mellitus

Pascale H. Lane, Michael W. Steffes, Paola Fioretto, S. Michael Mauer

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Eighty-four patients with insulin-dependent diabetes mellitus had studies of renal function and quantitative renal morphometry including mesangial volume fraction (Vvmes/glom), index of arteriolar hyalinosis, percentage of globally sclerosed glomeruli (%GS), and interstitial volume fraction for total renal cortex (Vvint/T). There was significant correlation among these four parameters, and all four structural parameters correlated with glomerular filtration rate and the log of urinary albumin excretion. Stepwise multiple regression analysis showed that Vvmes/glom and Vvint/T were additive, suggesting that they are partially independent. Arteriolar hyalinosis and %GS did not improve the correlations further. We hypothesize that Vvmes/glom, Vvint/T, arteriolar hyalinosis, and %GS represent multiple but probably interrelated pathologic mechanisms leading to the functional disturbances of diabetic nephropathy. Longitudinal studies of patients with diabetes and studies of patients with diseases producing interstitial expansion in the absence of glomerular disease may help clarify the independent role of interstitial expansion in the kidney disease of diabetes mellitus.

Original languageEnglish (US)
Pages (from-to)661-667
Number of pages7
JournalKidney international
Issue number3
StatePublished - Mar 1993

Bibliographical note

Funding Information:
Portions of these studies were presented at the annual meeting of the American Society of Nephrology, November 17, 1991, Baltimore, Maryland, and published in abstract form in the Journal of the Ameri-can Society of Nephrology 2:293, 1991. This work was supported by grants from the NIH (DK 1083, DK 43605, M01-RR00400) and The Juvenile Diabetes Foundation. Dr. Lane's fellowship was provided by the American Diabetes Association Mentor-Based Program. We thank John Basgen and Thomas Groppoli for their technical assistance. We appreciate the patient care provided by the staff of the Clinical Research Center at the University of Minnesota Hospital and Clinics.


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