Home | DM and Kidney |

Diabetes and the Kidney

Proteinuria in type 1 diabetic patients with less than 10 years of diabetes duration or type 2 diabetic patients without retinopathy should be thoroughly evaluated for other renal diseases and renal biopsy for diagnosis and prognosis should be strongly considered.

 

 
Frank Tenney MD

Image: Natural History of Type I Diabetic Nephropathy

Image: Clinical Evaluation of Diabetic Nephropathy

Image: Prevalence and incidence of microalbuminuria and overt proteinuria in type 1 and type 2 diabetes.

Image: Albuminuria in type 1 diabetics and the development of hypertension, retinopathy, and neuropathy

 

 

Pathology of diabetic nephropathy in patients with type 1 diabetes and proteinuria
Always Present
Often / Usually Present
Sometimes Present
Glomerular basement membrane thickening* Kimmelstiel-Wilson nodules (nodular glomerulosclerosis)*, global glomerular sclerosis; focal-segmental glomerulosclerosis, atubular glomeruli Hyaline “exudative” lesions (subendothelial)^
Tubular basement membrane thickening* Foci of tubular atrophy Capsular drops^
Mesangial expansion with predominance of increased mesangial matrix (diffuse
glomerulosclerosis)*		   Atherosclerosis
Interstitial expansion with predominance of increased extracellular matrix material   Glomerular
microaneurisms
Increased glomerular basement membrane, tubular basement membrane, and Bowman capsule staining for albumin and IgG* Afferent and efferent arteriolar hyalinosis*  
* in combination, diagnostic of diabetic nephropathy ^highly characteristic of diabetic nephropathy Brenner and Rector's The Kidney, 8th ed, Chapter 36 Table 36-1

Light microscopy of structural changes in diabetic nephropathy. (Comprehensive Clinical Nephrology, 2nd ed, Johnson/Feehally)

Image: Normal glomerulus (periodic acid–Schiff (PAS) stain)

Image: Diffuse glomerular lesion: widespread mesangial expansion (PAS stain)

Image: Nodular lesion: as well as mesangial expansion there is a typical Kimmelstiel–Wilson nodule at the top of the glomerulus (arrow) (PAS stain.) 

Image: Nodular lesion: methenamine silver staining showing the marked nodular expansion of mesangial matrix.

Electron microscopy of structural changes in diabetic nephropathy

Image: Glomerular basement membranes are diffusely thickened.

Image: The expanded mesangium encroaches on the capillary spaces (arrows).

Pathogenesis, Prevention, and Treatment of Diabetic Nephropathy

Image: Mechanism of formation of advanced glycation endproducts (AGEs).

Image: Immunohistochemical localization of advanced glycated endproducts (AGEs) in diabetic rodents / treated rodents

Diabetes is associated with increased deposition of AGEs in the glomerulus which is prevented by aminoguanidine therapy.

Image: Postulated mechanisms for the renoprotective effect of angiotensin–converting enzyme (ACE) inhibitors.