Changes in Albuminuria But Not GFR are Associated with Early Changes in Kidney Structure in Type 2 Diabetes

Autor: Behzad Najafian, Helen C. Looker, Robert G. Nelson, Cordell A. Esplin, Paolo Guarnieri, Jennifer L. Harder, Michael Mauer, Jon Hill, Carine M. Boustany-Kari, Matthias Kretzler, Pierre Jean Saulnier, Viji Nair
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
Time Factors
Urinary system
030232 urology & nephrology
Urology
Type 2 diabetes
030204 cardiovascular system & hematology
Kidney Function Tests
urologic and male genital diseases
Losartan
Diabetic nephropathy
03 medical and health sciences
0302 clinical medicine
Biopsy
Albuminuria
Humans
Medicine
Diabetic Nephropathies
Clinical Epidemiology
skin and connective tissue diseases
Analysis of Variance
Kidney
Type 1 diabetes
medicine.diagnostic_test
urogenital system
business.industry
Glomerular basement membrane
Biopsy
Needle
General Medicine
Middle Aged
medicine.disease
Immunohistochemistry
female genital diseases and pregnancy complications
medicine.anatomical_structure
Diabetes Mellitus
Type 2
Nephrology
Disease Progression
Indians
North American
Linear Models
Female
medicine.symptom
business
Glomerular Filtration Rate
Zdroj: J Am Soc Nephrol
ISSN: 1533-3450
1046-6673
DOI: 10.1681/asn.2018111166
Popis: Background In type 1 diabetes, changes in the GFR and urine albumin-to-creatinine ratio (ACR) are related to changes in kidney structure that reflect disease progression. However, such changes have not been studied in type 2 diabetes. Methods Participants were American Indians with type 2 diabetes enrolled in a clinical trial of losartan versus placebo. We followed a subset who underwent kidney biopsy at the end of the 6-year trial, with annual measurements of GFR (by urinary clearance of iothalamate) and ACR. Participants had a second kidney biopsy after a mean follow-up of 9.3 years. We used quantitative morphometric analyses to evaluate both biopsy specimens. Results Baseline measures for 48 participants (12 men and 36 women, mean age 45.6 years) who completed the study included diabetes duration (14.6 years), GFR (156 ml/min), and ACR (15 mg/g). During follow-up, glomerular basement membrane (GBM) width, mesangial fractional volume, and ACR increased, and surface density of peripheral GBM and GFR decreased. After adjustment for sex, age, ACR, and each morphometric variable at baseline, an increase in ACR during follow-up was significantly associated with increases in GBM width, mesangial fractional volume, and mean glomerular volume, and a decrease in surface density of peripheral GBM. Decline in GFR was not associated with changes in these morphometric variables after additionally adjusting for baseline GFR. Conclusions In American Indians with type 2 diabetes and preserved GFR at baseline, increasing ACR reflects the progression of earlier structural glomerular lesions, whereas early GFR decline may not accurately reflect such lesions.
Databáze: OpenAIRE
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