Structural involvement in type 1 and type 2 diabetic nephropathy

M. Dalla Vestra, A. Saller, E. Bortoloso, M. Mauer, P. Fioretto

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Abstract

Structural changes underlying diabetic nephropathy in Type 1 diabetes are prodominant in the glomerulus [thickening of glomerular basement membrane (GBM) and mesangial expansion], but also include arteriolar, tubular and interstitial lesions. The structural measure that correlates best with all renal functional parameters in Type 1 diabetes is mesangial fractional volume [Vv(mes/glom)], an estimate of mesangial expansion. Structural-functional relationships in Type 2 diabetes are much less known. These studies investigated renal structure in the early stages of nephropathy [microalbuminuria (MA)] in patients with Type 1 and Type 2 diabetes. Diabetic glomerulopathy was quite advanced in Type 1 diabetic patients with MA, and both Vv (mes/glom) and GBM width were increased as compared to normoalbuminuric (NA) patients when the albumin excretion rate (AER) was > 30 μg/min. Serial renal biopsies were performed 5 years apart in 11 Type 1 diabetic patients to evaluate whether glomerular and interstitial lesions progress jointly. AER increased significantly in 5 years, while the glomerular filtration rate remained unchanged. All structural parameters were initially abnormal. Vv(mes/glom) and mean glomerular volume increased significantly, whereas GBM width and the interstitial volume fraction were unchanged. Moreover, the change in Vv(mes/glom) was correlated with the change in AER (r = 0.64, p < 0.05). Thus, at the disease stage during which some patients progress to MA or proteinuria, continuing mesangial expansion is the main variable, whereas further interstitial expansion does not occur. A large number of Type 2 patients were also studied. Early diabetic glomerulopathy was detected by electron microscopy in NA patients and found to be more advanced in those with MA and proteinuria. However, lesions were milder than in Type 1 diabetic patients, and there was considerable overlap between groups. Morphometric results by electron microscopy were similar to those by light microscopy, demonstrating the heterogeneity of renal structure in Type 2 diabetic patients. In fact, only 30% of MA patients had typical diabetic glomerulopathy, while 40% had more advanced tubulo-interstitial and/or vascular lesions and 30% had normal renal structure.

Original languageEnglish (US)
Pages (from-to)8-14
Number of pages7
JournalDiabetes and Metabolism
Volume26
Issue numberSUPPL. 4
StatePublished - Aug 24 2000

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Diabetic Nephropathies
Glomerular Basement Membrane
Kidney
Albumins
Type 1 Diabetes Mellitus
Proteinuria
Type 2 Diabetes Mellitus
Electron Microscopy
Glomerular Filtration Rate
Blood Vessels
Microscopy
Biopsy
Light

Keywords

  • Mesangial expansion
  • Microalbuminuria
  • Morphometric analysis
  • Renal structure
  • Type 1 diabetes
  • Type 2 diabetes

Cite this

Vestra, M. D., Saller, A., Bortoloso, E., Mauer, M., & Fioretto, P. (2000). Structural involvement in type 1 and type 2 diabetic nephropathy. Diabetes and Metabolism, 26(SUPPL. 4), 8-14.

Structural involvement in type 1 and type 2 diabetic nephropathy. / Vestra, M. Dalla; Saller, A.; Bortoloso, E.; Mauer, M.; Fioretto, P.

In: Diabetes and Metabolism, Vol. 26, No. SUPPL. 4, 24.08.2000, p. 8-14.

Research output: Contribution to journalArticle

Vestra, MD, Saller, A, Bortoloso, E, Mauer, M & Fioretto, P 2000, 'Structural involvement in type 1 and type 2 diabetic nephropathy', Diabetes and Metabolism, vol. 26, no. SUPPL. 4, pp. 8-14.
Vestra MD, Saller A, Bortoloso E, Mauer M, Fioretto P. Structural involvement in type 1 and type 2 diabetic nephropathy. Diabetes and Metabolism. 2000 Aug 24;26(SUPPL. 4):8-14.
Vestra, M. Dalla ; Saller, A. ; Bortoloso, E. ; Mauer, M. ; Fioretto, P. / Structural involvement in type 1 and type 2 diabetic nephropathy. In: Diabetes and Metabolism. 2000 ; Vol. 26, No. SUPPL. 4. pp. 8-14.
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