Prevalence of atubular glomeruli in type 2 diabetic patients with nephropathy.
BACKGROUND
Atubular glomeruli have been identified in a number of chronic renal diseases and have been linked to declining renal function. In type 1 diabetes they are present predominantly in proteinuric patients. We investigated the prevalence of atubular glomeruli in type 2 diabetes and their relationship to renal function.


METHODS
Renal biopsies from 12 type 2 diabetic patients with nephropathy were processed for light and electron microscopy and analysed using standard stereological techniques. Abnormalities at the glomerular tubular junction were quantified using an index of junctional atrophy (IJA).


RESULTS
There was no relationship between the degree of proteinuria and the presence of atubular glomeruli or atrophic tubules. Creatinine clearance correlated with the IJA (r = -0.70, P = 0.011), percent sclerosed glomeruli (r = -0.59, P = 0.027) and interstitial volume fraction (r = -0.54, P = 0.037). The IJA also correlated with foot process width and volume fraction interstitium (r = 0.58, P = 0.049 for both). Percent sclerosed glomeruli correlated with mesangial (r = 0.65, P = 0.012) and interstitial (r = 0.69, P = 0.007) volume fractions.


CONCLUSIONS
In contrast to type 1 diabetes, atubular glomeruli and atrophic tubules occur in type 2 diabetic patients with low levels of proteinuria; their development may influence the progressive change in GFR. Both glomerular and interstitial damage may lead to the development of atubular glomeruli in type 2 diabetic nephropathy.
School of Clinical Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. k.e.white@ncl.ac.uk
Kathryn E
KE
White
Sally M
SM
Marshall
Rudolf W
RW
Bilous
D000328:Adult; D001284:Atrophy / Q000473:pathology; D001706:Biopsy; D016022:Case-Control Studies; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000473:pathology*; D003928:Diabetic Nephropathies / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011507:Proteinuria / Q000473:pathology / Q000652:urine; D012044:Regression Analysis
D003404:Creatinine