Nephrology Dialysis Transplantation, Vol 13, Issue 10 2547-2552, Copyright © 1998 by Oxford University Press
M Schwartz, E Lewis, T Leonard-Martin, J Lewis, D Batlle and T Collaborative Study Group
Background. The glomerular and retinal vessels are
both affected in patients with type I and type II diabetes mellitus.
However, the prevalence of the nodular form of diabetic glomerular
sclerosis (Kimmelstiel-Wilson lesion) and other forms of glomerular
pathology including diffuse mesangial sclerosis and their clinical
correlates in type II diabetes are less well known. In addition, although
recent studies have suggested that non-diabetic glomerular disease was a
common cause of proteinuria in type II diabetes, the prevalence of other
disease is unknown. The literature on this subject is clouded by clinical
bias regarding patients with diabetes who undergo renal biopsy.
Methods. Glomerular and retinal pathology and clinical
correlates were studied in 36 patients enrolled in a prospective clinical
trial of patients with type II diabetes mellitus, proteinuria, renal
insufficiency, and hypertension. Results. Seventeen
biopsies had diabetic glomerular sclerosis with Kimmelstiel-Wilson nodules;
15 biopsies had glomerular changes characteristic of the diabetic state
including enlarged glomeruli and an increase in mesangial matrix without
Kimmelstiel-Wilson nodules (mesangial sclerosis lesion); and two had other
primary glomerular diseases (IgA and membranous nephropathy). Patients with
Kimmelstiel-Wilson nodules had elevated serum creatinines compared to
patients with mesangial sclerosis lesions, but there were no other
significant differences. Patients with Kimmelstiel-Wilson nodules had more
severe overall retinopathy than those with mesangial sclerosis lesions
(P=0.0043): six of seven with proliferative
retinopathy had Kimmelstiel-Wilson nodules, and seven of the eight patients
without retinopathy had mesangial sclerosis lesions. Conclusions.
The two discrete patterns of glomerular pathology and the
correlation between diabetic retinopathy and the Kimmelstiel-Wilson lesion
but not the mesangial sclerosis lesion suggest that the Kimmelstiel-Wilson
and mesangial sclerosis lesions of diabetic glomerulosclerosis are caused
by different pathogenetic mechanisms. In this study, diabetic
glomerulosclerosis was responsible for the clinical renal abnormalities in
94% of patients with type II diabetes mellitus. Keywords:
diabetes mellitus; glomerulopathy; Kimmelstiel-Wilson;
retinopathy; type II; renal failure
ORIGINAL ARTICLES
Renal pathology patterns in type II diabetes mellitus: relationship with retinopathy
Department of Pathology and Section of Nephrology, Department of Medicine, Rush Medical College, Chicago, IL, USA; Section of Nephrology and Section of Ophthalmology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA; Division of Nephrology/Hypertension, Department of Medicine, Northwestern University Medical School, Chicago, IL, USA; Various; Corresponding author address: Department of Pathology, Rush-Presbyterian St Luke's Medical Center, 1753 W. Congress Parkway, Chicago, IL 60612, USA
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