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Histological predictors for renal prognosis in diabetic nephropathy in type 2 diabetes patients with overt proteinuria.
MedLine Citation:
PMID:  21933307     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background:  Although several clinical risk factors for end-stage renal disease in diabetic nephropathy are known, the pathological findings which may help predict renal prognosis have not yet been defined. Patients and methods:  We enrolled 69 type 2 diabetes patients with overt proteinuria and biopsy-confirmed diabetic nephropathy with mesangial expansion, and retrospectively examined the association of histological and clinical findings with renal outcome. The median follow-up duration was 52 months. Histological scoring was made according to that of Tervaert et al. Patients were divided into 4 groups according to glomerular classification (class 2a, mild mesangial expansion, n = 11; class 2b, severe mesangial expansion without nodular sclerosis, n = 15; class 3, nodular sclerosis, n = 36; class 4, global glomerulosclerosis observed in more than 50% of glomeruli, n = 7). Interstitial and vascular lesions were scored for each patient. A renal event was defined as a condition requiring the initiation of chronic dialysis or doubling of the serum creatinine level. Results:  Cox proportional hazard analysis showed that the glomerular classes were not significant variables, while interstitial fibrosis, tubular atrophy and interstitial inflammation were independent variables associated with renal end-point (HR: 3.36 (95% confidence interval: 1.21-9.32), 4.74 (1.26-17.91)). There were no significant differences in the renal survival rates between the glomerular classes 2a and 2b combined group and the glomerular class 3 group (p = 0.17, log-rank test). Conclusion:  Interstitial lesions but not glomerular lesions were a significant predictor for renal prognosis in diabetic nephropathy in type 2 diabetes patients with overt proteinuria.
Authors:
Tomonari Okada; Toshitaka Nagao; Hiroshi Matsumoto; Yume Nagaoka; Toshikazu Wada; Toshiyuki Nakao
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-20
Journal Detail:
Title:  Nephrology (Carlton, Vic.)     Volume:  -     ISSN:  1440-1797     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9615568     Medline TA:  Nephrology (Carlton)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors. Nephrology © 2011 Asian Pacific Society of Nephrology.
Affiliation:
Departments of Nephrology and Anatomic Pathology Tokyo Medical University, Tokyo, Japan.
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