title: Renal prognosis a long time after renal biopsy on patients with diabetic nephropathy.
abstract: BACKGROUND
  A new classification of diabetic nephropathy was reported by Tervaert et al., but the association between pathological findings and the clinical outcomes remains unclear.
  
  
  METHODS
  Among 310 patients with diabetes mellitus who underwent renal biopsy from March 1985 to January 2010 and were confirmed to have diabetic nephropathy according to the Tervaert's classification, 205 patients were enrolled in this study. Cox proportional hazard regression analysis was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for death-censored renal death. Each regression analysis employed two levels of multivariate adjustment.
  
  
  RESULTS
  After adjustment for age, gender, estimated glomerular filtration rate, type of diabetes, urinary protein excretion, systolic blood pressure, body mass index, HbA1c, diabetic retinopathy and red blood cells in urinary sediment at the time of renal biopsy, compared with glomerular class IIA, the HRs for death-censored renal death of glomerular classes I, IIB, III and IV were 0.21 (95% CI: 0.04-1.25), 2.12 (0.89-5.04), 4.23 (1.80-9.90), and 3.27 (1.32-8.10), respectively. Also, compared with an interstitial fibrosis and tubular atrophy score 1 group, HRs for score 0 group, score 2 group and score 3 group were 0.08 (0.01-0.57), 2.17 (0.96-4.91), 4.78 (1.96-11.68), respectively.
  
  
  CONCLUSIONS
  The progression of glomerular, tubulointerstitial and vascular lesions was associated with higher HRs for renal death. These results suggest the clinical utility of Tervaert's pathological classification.
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Mise
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.forename: Rikako
authors.initials: R
authors.lastname: Hiramatsu
authors.forename: Eiko
authors.initials: E
authors.lastname: Hasegawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamanouchi
authors.forename: Noriko
authors.initials: N
authors.lastname: Hayami
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fujii
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ohashi
authors.forename: Shigeko
authors.initials: S
authors.lastname: Hara
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D002648:Child; D003928:Diabetic Nephropathies / Q000145:classification* / Q000401:mortality* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007150:Immunohistochemistry; D007678:Kidney Glomerulus / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D055815:Young Adult
keywords: diabetic nephropathy; pathological classification; renal prognosis