Abstract
Background
Several clinical parameters and pathological findings are known to be predictors of the deterioration of diabetic nephropathy (DN). Glomerular basement membrane duplication (GBM-DP) is a pathological feature representing endothelial injury, which is commonly observed in DN. In the present study, we investigated the association between GBM-DP and the renal prognosis in DN.
Methods
The study enrolled 80 patients with renal biopsy-proven DN who were managed at Chiba-East Hospital from 2005 to 2012. We confirmed the pathological findings according to the Renal Pathology Society classifications, and we further evaluated the GBM-DP, which was defined as double contours of the GBM that expanded more than 10% of capillary loops in the most affected nonsclerotic glomerulus. We used Cox regression models to estimate hazard ratios (HRs) for end-stage renal disease (ESRD), with adjustment for age, sex, systolic blood pressure, HbA1c, estimated glomerular filtration rate (eGFR), and urinary protein excretion (UP) at baseline.
Results
Of the 80 patients, 56 were male (70.0%) and the mean age was 59.1 years. The median eGFR and UP were 42 ml/min/1.73 m2 (IQR 30, 59) and 3.1 g/gCr (IQR 1.2, 5.2). Twenty-seven patients progressed to ESRD and one patient died during the median observational period of 2.9 years (IQR 1.5, 4.3). The multivariable analyses showed that GBM-DP was significantly associated with ESRD (HR 3.18 [95% confidence interval (CI): 1.02–9.87], p = 0.045).
Conclusion
We newly identified GBM-DP as a strong prognostic predictor in DN patients. Further study is needed to clarify the pathogenic mechanism of GBM-DP in DN.
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Acknowledgements
This research was supported by the Kashiwado memorial foundation (to T.Y).
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The protocol of this study was approved by the ethics committee of National Hospital Organization Chiba-East Hospital in July 2016 (IRB Approval No.9), and all study procedures adhered to the Declaration of Helsinki.
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Informed consent was obtained from all individual participants included in the study.
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Yamakawa, T., Kawaguchi, T., Kitamura, H. et al. Glomerular basement membrane duplication is a predictor of the prognosis of diabetic nephropathy in patients with type 2 diabetes. Clin Exp Nephrol 23, 521–529 (2019). https://doi.org/10.1007/s10157-018-1674-z
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DOI: https://doi.org/10.1007/s10157-018-1674-z