title: Early histologic lesions and risk factors for recurrence of diabetic kidney disease after kidney transplantation.
abstract: BACKGROUND
  Recurrence of diabetic kidney disease (DKD) after diabetic kidney transplantation has been reported. The aim of this study was to determine the early histologic lesions, focusing especially on abnormal glomerular angiogenesis, and clinical risk factors of recurrent DKD after kidney transplantation.
  
  
  METHODS
  The authors studied 34 renal transplant recipients with diabetes and 30 without diabetes. All patients had undergone both baseline and posttransplant follow-up biopsies. Glomerular morphometric analyses of the mesangial area, the capillary number, and the capillary area were performed with a computer-assisted image analyzer, and glomerular basement membrane (GBM) thickness was evaluated by electron microscopy. The incidence of polar vasculosis as an angiogenic phenomenon was also evaluated. Clinical data including hemoglobin (Hb)A1c, blood pressure, urinary albumin excretion, and serum lipid profiles were compared with histologic parameters.
  
  
  RESULTS
  Together with the increased glomerular mesangial area and GBM thickness, the glomerular capillary number and area and the incidence of polar vasculosis were significantly higher in patients with diabetes. Most of these alterations were significantly associated with the mean posttransplant HbA1c levels but not with blood pressure or lipid profiles. In the multiple regression analysis, HbA1c level remained significantly associated with these histologic parameters.
  
  
  CONCLUSIONS
  Similar to mesangial expansion and GBM thickening, glomerular neovascularization represented by increased capillary number and area and glomerular polar vasculosis can occur as an early diabetic lesion in recurrent DKD. Posttransplant hyperglycemia is a significant risk factor predictive of the progression of recurrent DKD in kidney allografts.
authors.affiliation: Department of Medicine, Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Nyumura
authors.forename: Kazuho
authors.initials: K
authors.lastname: Honda
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teraoka
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Iwamoto
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001794:Blood Pressure; D016022:Case-Control Studies; D003928:Diabetic Nephropathies / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D050533:Glomerular Basement Membrane / Q000648:ultrastructure; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007564:Japan; D007678:Kidney Glomerulus / Q000098:blood supply / Q000473:pathology* / Q000648:ultrastructure; D016030:Kidney Transplantation / Q000009:adverse effects*; D016014:Linear Models; D008055:Lipids / Q000097:blood; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D015999:Multivariate Analysis; D009389:Neovascularization, Pathologic; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D008055:Lipids; C517652:hemoglobin A1c protein, human