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Renal structure in type 2 diabetes: facts and misconceptions
Angelo Di Vincenzo1, Silvia Bettini1, Lucia Russo1
1Department of Medicine, Clinica Medica 3, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
Abstract:
The clinical manifestations of diabetic nephropathy are similar in type 1 and type 2 diabetes, while the renal lesions may differ. Indeed, diabetic glomerulopathy is the predominant renal lesion in type 1 diabetes, although also tubular, interstitial and arteriolar lesions are present in the advanced stages of renal disease. In contrast, in type 2 diabetes renal lesions are heterogeneous, and a substantial number of type 2 diabetic patients with diabetic kidney disease have mild or absent glomerulopathy with tubulointerstitial and/or arteriolar abnormalities. In addition, a high prevalence of non-diabetic renal diseases, isolated or superimposed on classic diabetic nephropathy lesions have been reported in patients with type 2 diabetes, often reflecting the bias of selecting patients for unusual clinical presentations for renal biopsy. This review focuses on renal structural changes in type 2 diabetes, emphasizing the contribution of research kidney biopsy studies to the understanding of the pathogenesis of DKD and of the structural lesions responsible for the different clinical phenotypes. Also, kidney biopsies could provide relevant information in terms of renal prognosis, and help to understand the different responses to different therapies, especially SGLT2 inhibitors, thus allowing personalized medicine.
Insights
Diabetic kidney disease (DKD) presents differently in type 2 diabetes, often with varied renal lesions beyond glomerulopathy. Kidney biopsies reveal these structural changes, aiding prognosis and personalized treatment, including SGLT2 inhibitors.
Area of Science:
- Nephrology
- Endocrinology
- Pathology
Background:
- Clinical presentation of diabetic nephropathy is similar in type 1 and type 2 diabetes.
- Renal lesions in type 1 diabetes predominantly feature diabetic glomerulopathy.
- Type 2 diabetes exhibits heterogeneous renal lesions, often with tubulointerstitial and arteriolar abnormalities, and sometimes mild or absent glomerulopathy.
Purpose of the Study:
- To review renal structural changes in type 2 diabetes.
- To highlight the role of kidney biopsy studies in understanding diabetic kidney disease (DKD) pathogenesis and clinical phenotypes.
- To explore the utility of kidney biopsies for renal prognosis and personalized medicine, particularly regarding SGLT2 inhibitor response.
Main Methods:
- Review of existing literature and research kidney biopsy studies.
- Analysis of structural renal lesions in type 2 diabetes patients.
- Correlation of histological findings with clinical presentations and outcomes.
Main Results:
- Type 2 diabetes frequently shows heterogeneous renal lesions, including tubulointerstitial and arteriolar abnormalities, alongside potential non-diabetic renal diseases.
- Kidney biopsies are crucial for identifying specific structural lesions contributing to diverse clinical phenotypes in DKD.
- Histopathological findings from biopsies can inform renal prognosis and guide personalized therapeutic strategies.
Conclusions:
- Renal structural changes in type 2 diabetes are diverse and impact clinical outcomes.
- Kidney biopsies are essential for accurate diagnosis, prognosis, and personalized treatment of DKD.
- Understanding specific renal lesions may optimize the use of therapies like SGLT2 inhibitors for tailored patient care.
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