Nationwide multicentre kidney biopsy study of Japanese patients with type 2 diabetes.
The clinical and pathologic manifestations of nephropathy due to type 2 diabetes are diverse, but large-scale pathologic studies with long-term observations are limited.



Kidney biopsies and clinical data of 600 patients with type 2 diabetes were collected retrospectively from 13 centres across Japan. Thirteen pathologic findings (nine glomerular lesions, two interstitial lesions and two vascular lesions) were clearly defined and scored.



During the observation period, there were 304 composite kidney events [dialysis, doubling of creatinine or reduction of estimated glomerular filtration rate (eGFR) by half], 31 instances of chronic kidney disease (CKD) G5D, 76 cardiovascular events and 73 deaths. The mean observation period was 72.4 months. The distribution of CKD heat map categories for the 600 patients was 103 green or yellow, 149 orange and 348 red. Even in the cases in the green and yellow category, diffuse lesions (81.6%), polar vasculosis (42.6%) and subendothelial space widening (35.1%) were commonly detected. Cox proportional hazard analysis revealed that the presence of nodular lesions [hazard ratio (HR) 21.1, 95% confidence interval (CI) 5.3-84.6], exudative lesions (HR 5.1, 95% CI 1.3-20.3) and mesangiolysis (HR 7.6, 95% CI 2.0-28.8) in cases in the green and yellow category were associated with significantly great impact on composite kidney events after adjustment for clinical risk factors.



This nationwide study on kidney biopsy of 600 cases with type 2 diabetes revealed that pathologic findings (presence of nodular lesions, exudative lesions and mesangiolysis) were strong predictors of kidney events in low-risk patients.
Division of Nephrology, Kanazawa University Hospital, Ishikawa, Japan.
Kengo
K
Furuichi
Department of Nephrology, Fujita Health University Hospital, Aichi, Japan.
Yukio
Y
Yuzawa
Division of Nephrology, Kanazawa University Hospital, Ishikawa, Japan.
Miho
M
Shimizu
Division of Nephrology, Kanazawa University Hospital, Ishikawa, Japan.
Akinori
A
Hara
Division of Nephrology, Kanazawa University Hospital, Ishikawa, Japan.
Tadashi
T
Toyama
Department of Pathology, Clinical Research Center, National Hospital Organization Chiba East National Hospital, Chiba, Japan.
Hiroshi
H
Kitamura
Health Administration Center, Niigata University, Niigata, Japan.
Yoshiki
Y
Suzuki
Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
Hiroshi
H
Sato
Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Noriko
N
Uesugi
Nephrology Center, Toranomon Hospital, Tokyo, Japan.
Yoshifumi
Y
Ubara
Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Satoshi
S
Hisano
Department of Diagnostic Pathology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.
Yoshihiko
Y
Ueda
Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Hyogo, Japan.
Shinichi
S
Nishi
Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan.
Hitoshi
H
Yokoyama
Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
Tomoya
T
Nishino
Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus School of Medicine, Okinawa, Japan.
Kentaro
K
Kohagura
Department of Diabetic Nephropathy, Okayama University, Okayama, Japan.
Daisuke
D
Ogawa
Department of Diabetic Nephropathy, Okayama University, Okayama, Japan.
Koki
K
Mise
Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.
Yugo
Y
Shibagaki
Tokyo Takanawa Hospital, Tokyo, Japan.
Kenjiro
K
Kimura
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan.
Masakazu
M
Haneda
Department of Diabetic Nephropathy, Okayama University, Okayama, Japan.
Hirofumi
H
Makino
Division of Nephrology, Department of Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Seiichi
S
Matsuo
Division of Nephrology, Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan.
Takashi
T
Wada
D000328:Adult; D000368:Aged; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000145:classification / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
D003404:Creatinine
CKD heat map; diabetes mellitus; diabetic nephropathy; kidney biopsy; nodular lesion