Predilection of segmental glomerulosclerosis lesions for the glomerulotubular junction area in type 1 diabetic patients: a novel mapping method.
The location of segmental glomerular lesions in relation to the vascular or tubular pole may have diagnostic or prognostic significance. We have developed a model-based method to estimate the distance from a glomerular lesion to a given landmark (vascular or tubular pole) or the glomerular center and applied this to biopsies from 5 microalbuminuric, 5 normoalbuminuric and 7 proteinuric type 1 diabetic patients and 5 normal controls. The distance from each glomerular adhesion to the glomerulotubular junction was measured and divided by the glomerular radius, allowing comparability among different glomeruli, assuming a spherical shape for Bowman's capsule, an assumption which was validated. The frequency of adhesions in 6 glomerular zones with equal height (zone I adjacent to the glomerulotubular junction and zones II-VI progressively farther away) was determined: 59% of adhesions were in zone I, 15% in zone II, 16% in zone III, 7% in zone IV and 3% in zone VI (adjacent to the hilus). In glomeruli with only one adhesion, 82% of these were in zone I. This new method accurately localizes segmental lesions within glomeruli and revealed a marked predilection in type 1 diabetic patients for segmental sclerosis to develop at the glomerulotubular junction.
Department of Pathology, University of Washington, Seattle, Washington, United States of America. najafian@uw.edu
Behzad
B
Najafian
Michael
M
Mauer
D000293:Adolescent; D001706:Biopsy; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology* / Q000652:urine; D003928:Diabetic Nephropathies / Q000473:pathology* / Q000652:urine; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology* / Q000652:urine; D006651:Histocytochemistry; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D007684:Kidney Tubules / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000473:pathology* / Q000652:urine