Nationwide multicentre kidney biopsy study of Japanese patients with type 2 diabetes

Kengo Furuichi, Yukio Yuzawa, Miho Shimizu, Akinori Hara, Tadashi Toyama, Hiroshi Kitamura, Yoshiki Suzuki, Hiroshi Sato, Noriko Uesugi, Yoshifumi Ubara, Satoshi Hisano, Yoshihiko Ueda, Shinichi Nishi, Hitoshi Yokoyama, Tomoya Nishino, Kentaro Kohagura, Daisuke Ogawa, Koki Mise, Yugo Shibagaki, Kenjiro KimuraMasakazu Haneda, Hirofumi Makino, Seiichi Matsuo, Takashi Wada

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background. The clinical and pathologic manifestations of nephropathy due to type 2 diabetes are diverse, but large-scale pathologic studies with long-termobservations are limited. Methods. 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. Results. 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. Conclusions. 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.

Original languageEnglish
Pages (from-to)138-148
Number of pages11
JournalNephrology Dialysis Transplantation
Volume33
Issue number1
DOIs
Publication statusPublished - 2018 Jan 1

Keywords

  • CKD heat map
  • Diabetes mellitus
  • Diabetic nephropathy
  • Kidney biopsy
  • Nodular lesion

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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    Furuichi, K., Yuzawa, Y., Shimizu, M., Hara, A., Toyama, T., Kitamura, H., Suzuki, Y., Sato, H., Uesugi, N., Ubara, Y., Hisano, S., Ueda, Y., Nishi, S., Yokoyama, H., Nishino, T., Kohagura, K., Ogawa, D., Mise, K., Shibagaki, Y., ... Wada, T. (2018). Nationwide multicentre kidney biopsy study of Japanese patients with type 2 diabetes. Nephrology Dialysis Transplantation, 33(1), 138-148. https://doi.org/10.1093/ndt/gfw417