[Early renal changes in type 1 diabetes]

The relationships between renal structural abnormalities, metabolic, and hemodynamic changes were studied in 35 type diabetic patients with normal creatinine clearance. Sixteen patients had normal urinary albumin excretion (UAE) rates, 17 were microalbuminuric and 2 had proteinuria (0.68 and 0.8 g/day). Light and electron microscopy revealed the early stages of diffuse glomerulosclerosis, tubular dystrophy and atrophy, intestinal and arteriolar sclerosis in the renal biopsy specimens of the examinees. Increased UAE was associated with the reduced percent of glomerular podocytes, the thickening and fusion of small podocytic processes, the increased thickness of the glomerular and tubular basement membrane, the reduced number of endothelial fenestrae, the increased fractional volume of the mesangium, perioglomerular sclerosis, global sclerosis of some glomeruli, tubular endothelial atrophy, and intestinal and arteriolar sclerosis. Clycemic control, diabetes duration, albumin excretion rate, and blood pressure are the predictors of early renal structural changes.