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Structural involvement in type 1 and type 2 diabetic nephropathy.

M Dalla Vestra¹, A Saller, E Bortoloso

¹Department of Medical and Surgical Sciences, University of Padua, Italy.

Diabetes & Metabolism

|August 3, 2000

Summary

Diabetic nephropathy involves glomerular changes like mesangial expansion, which worsens over time in Type 1 diabetes. Early kidney damage in Type 2 diabetes shows varied structural changes, often less severe than in Type 1.

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Area of Science:

Nephrology
Diabetology
Pathology

Background:

Diabetic nephropathy (DN) is a major complication of diabetes mellitus.
Structural changes in DN include glomerular basement membrane (GBM) thickening and mesangial expansion.
Mesangial fractional volume [Vv(mes/glom)] best correlates with renal function in Type 1 diabetes.

Purpose of the Study:

Investigate renal structure in early stages of nephropathy (microalbuminuria) in Type 1 and Type 2 diabetes.
Evaluate joint progression of glomerular and interstitial lesions in Type 1 diabetes over 5 years.
Characterize structural-functional relationships in Type 2 diabetes.

Main Methods:

Renal biopsies analyzed using light and electron microscopy.
Morphometric analysis including Vv(mes/glom) and GBM width.

Related Experiment Videos

Serial biopsies in Type 1 diabetic patients over 5 years.

Main Results:

Type 1 diabetes with microalbuminuria showed advanced glomerulopathy (increased Vv(mes/glom), GBM width).
In Type 1 diabetes, Vv(mes/glom) and glomerular volume increased over 5 years, correlating with albumin excretion rate (AER).
Type 2 diabetes exhibited heterogeneous renal lesions, with typical diabetic glomerulopathy in only 30% of microalbuminuria patients.

Conclusions:

Continuing mesangial expansion is a key factor in DN progression at the microalbuminuria stage.
Renal structural changes in early Type 2 diabetes are diverse and often milder than in Type 1.
Morphometric analysis is crucial for understanding DN heterogeneity.