Skip to main content
SpringerLink
Log in

Glomerular structure and function in proteinuric Type 2 (non-insulin-dependent) diabetic patients

  • Published:
Diabetologia Aims and scope Submit manuscript

Summary

Glomerular ultrastructure was examined in a series of 20 Type 2 (non-insulin-dependent) diabetic patients with proteinuria. Reference was made to data previously obtained in non-diabetic kidney donors and in Type 1 (insulindependent) diabetic patients with similar degrees of proteinuria. The Type 2 diabetic patients demonstrated the changes which characterize the diabetic glomerulopathy seen in Type 1 diabetic patients: basement membrane thickening, and increase in the mesangium and mesangial matrix expressed as fraction of the glomerular volume. Among the Type 2 diabetic patients there was more variation then among the Type 1 diabetic patients, as this group included subjects with normal parameters. The group means and coefficients of variation (=SD/mean) of the glomerulopathy parameters combined in the glomerulopathy index=basement membrane thickness/10+Vv(matrix/glom)·100 were 81 (0.30) and 92 (0.15) in the two diabetic groups, clearly different from the non-diabetic index, 42 (0.16). All Type 2 diabetic patients who also had retinopathy had a glomerulopathy index above the normal range. Similar changes in glomerular composition were seen in the two diabetic groups: with increasing glomerulopathy the volume of matrix dominated over the peripheral basement membrane, and a shift in the ratio of interfaces was seen: mesangial surface towards capillary lumen increased relative to the urinary surface, and peripheral capillary surface comprised less of the total capillary surface. Data indicated marked glomerular hypertrophy, which correlated with the mesangial volume fraction, thus encompassing preserved filtration surface per glomerulus. An inverse correlation obtained between the index of glomerulopathy and current glomerular filtration rate, as well as the ensuing rate of decline in glomerular filtration rate, as well as the ensuing rate of decline in glomerular filtration rate: (index (glomerulopathy) vs rate of decline in glomerular filtration rater=0.84,p<0.0001). No correlation was found between glomerular volume and the ensuing rate of decline in glomerular filtration rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Schmitz A (1992) The kidney in non-insulin-dependent diabetes. Studies on glomerular structure and function and the relationship between microalbuminuria and mortality. Acta Diabetologica 29: 47–69

    Article  Google Scholar 

  2. Gall M-A, Nielsen FS, Smidt UM, Parving H-H (1993) The course of kidney function in type 2 (non-insulin-dependent) diabetic patients with diabetic nephropathy. Diabetologia 36: 1071–1078

    CAS  PubMed  Google Scholar 

  3. Fabre J, Balant LP, Dayer PG, Hilke MF, Vernet AT (1982) The kidney in maturity onset diabetes mellitus: a clinical study of 510 patients. Kidney Int 21: 730–738

    CAS  PubMed  Google Scholar 

  4. Tung P, Levin SR (1988) Nephropathy in non-insulin-dependent diabetes mellitus. Am J Med 85 [Suppl 5 A]: 131–136

    CAS  PubMed  Google Scholar 

  5. Mogensen CE (1987) Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 31: 673–689

    CAS  PubMed  Google Scholar 

  6. Schmitz A, Væth M (1988) Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabetic Med 5: 126–134

    CAS  PubMed  Google Scholar 

  7. Mauer SM, Steffes MW, Ellis EN, Sutherland DER, Brown DM, Goetz FC (1984) Structural-functional relationships in diabetic nephropathy. J Clin Invest 74: 1143–1155

    CAS  PubMed  Google Scholar 

  8. Østerby R, Parving H-H, Hommel E, Jørgensen HE, Løkkegaard H (1990) Glomerular structure and function in diabetic nephropathy: early to advanced stages. Diabetes 39: 1057–1063

    PubMed  Google Scholar 

  9. Kimmelstiel P, Wilson C (1936) Intercapillary lesions in the glomeruli of the kidney. Am J Pathol 12: 83–105

    Google Scholar 

  10. Schmitz A, Gundersen HJG, Østerby R (1988) Glomerular morphology by light microscopy in non-insulin-dependent diabetes mellitus. Lack of glomerular hypertrophy. Diabetes 37: 38–43

    CAS  PubMed  Google Scholar 

  11. Schmitz A, Nyengaard JR, Bendtsen TF (1990) Glomerular volume in type 2 (non-insulin-dependent) diabetes estimated by a direct and unbiased stereologic method. Lab Invest 62: 108–113

    CAS  PubMed  Google Scholar 

  12. Parving H-H, Gall M-A, Skøtt P et al. (1992) Prevalence and causes of albuminuria in non-insulin-dependent diabetic patients. Kidney Int 41: 758–762

    CAS  PubMed  Google Scholar 

  13. Hayashi H, Karasawa R, Inn H et al. (1992) An electron microscopic study of glomeruli in Japanese patients with non-insulin dependent diabetes mellitus. Kidney Int 41: 749–757

    CAS  PubMed  Google Scholar 

  14. Richards NT, Greaves I, Lee SJ, Howie AJ, Adu D, Michael J (1992) Increased prevalence of renal biopsy findings other than diabetic glomerulopathy in type II diabetes mellitus. Nephrol Dial Transplant 7: 379–399

    Google Scholar 

  15. Gall M-A, Rossing P, Skøtt P et al (1991) Prevalence of microand macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European type 2 (non-insulin-dependent) diabetic patients. Diabetologia 34: 655–661

    Article  CAS  PubMed  Google Scholar 

  16. Østerby R, Gundersen HJG, Nyberg G, Aurell M (1987) Advanced diabetic glomerulopathy. Quantitative structural characterization of non-occluded glomeruli. Diabetes 36: 612–619

    PubMed  Google Scholar 

  17. Brøchner-Mortensen J, Giese J, Rossing N (1969) Renal inulin clearance versus total plasma clearance of 51-Cr-EDTA. Scand J Clin Lab Invest 26: 5–11

    Google Scholar 

  18. Christensen C, Ørskov C (1984) Rapid screening PEG radioimmunoassay for quantitation of pathological microalbuminuria. Diabetic Nephropathy 3: 92–94

    Google Scholar 

  19. Østerby R, Nyberg G, Hedman L, Karlberg I, Persson H, Svalander C (1991) Kidney transplantation in type 1 (insulin-dependent) diabetic patients. Early glomerulopathy. Diabetologia 34: 668–674

    Article  PubMed  Google Scholar 

  20. Hirose K, Østerby R, Nozawa M, Gundersen HJG (1982) Development of glomerular lesions in experimental long-term diabetes in the rat. Kidney Int 21: 689–695

    CAS  PubMed  Google Scholar 

  21. Lane PH, Steffes MW, Mauer SM (1992) Estimation of glomerular volume: a comparison of four methods. Kidney Int 41: 1085–1089

    CAS  PubMed  Google Scholar 

  22. Walker JD, Close CF, Jones SL et al. (1992) Glomerular structure in type 1 (insulin-dependent) diabetic patients with normoand microalbuminuria. Kidney Int 41: 741–748

    CAS  PubMed  Google Scholar 

  23. Gundersen HJG, Bendtsen TF, Korbo L et al. (1988) Some new, simple and efficient stereological methods and their use in pathological research and diagnosis. APMIS 96: 379–394

    CAS  PubMed  Google Scholar 

  24. Jensen EB, Gundersen HJG, Østerby R (1979) Determination of membrane thickness distribution from orthogonal intercepts. J Microsc 115: 19–33

    CAS  PubMed  Google Scholar 

  25. Schmitz A, Hvid Hansen H, Christensen T (1989) Kidney function in newly diagnosed type 2 (non-insulin-dependent) diabetic patients, before and during treatment. Diabetologia 32: 434–439

    Article  CAS  PubMed  Google Scholar 

  26. Marre M, Hallab M, Roy J, Lejeune J-J, Jallet P, Fressinaud P (1992) Glomerular hyperfiltration in type I, type II, and secondary diabetes. J Diab Comp 6: 19–24

    CAS  Google Scholar 

  27. Vora JP, Dolben J, Dean JD et al. (1992) Renal hemodynamics in newly presenting non-insulin dependent diabetes mellitus. Kidney Int 41: 829–835

    CAS  PubMed  Google Scholar 

  28. Lundbæk K (1953) Long-term diabetes. Munksgaard, Copenhagen

    Google Scholar 

  29. Østerby R (1992) Glomerular structural changes in type 1 (insulin-dependent) diabetes: consequences, causes and prevention. Diabetologia 35: 803–812

    Article  PubMed  Google Scholar 

  30. Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A (1989) Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 32: 219–226

    CAS  PubMed  Google Scholar 

  31. Østerby R, Nyberg G (1987) New vessel formation in the renal corpuscles in advanced diabetic glomerulopathy. J Diabetic Compl 1: 122–127

    Google Scholar 

  32. Hostetter TH, Rennke HG, Brenner NM (1982) The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies. Am J Med 72: 375–380

    Article  CAS  PubMed  Google Scholar 

  33. Kaplan C, Pasternack B, Shah H, Gallo G (1975) Age-related incidence of sclerotic glomeruli in human kidneys. Am J Pathol 80: 227–234

    CAS  PubMed  Google Scholar 

  34. Kappel B, Olsen TS (1980) Cortical interstitial tissue and sclerosed glomeruli in human kidneys. Virchows Arch [A] 387: 271–277

    Article  CAS  Google Scholar 

  35. Hørlyck A, Gundersen HJG, Østerby R (1986) The cortical distribution pattern of diabetic glomerulopathy. Diabetologia 29: 146–150

    PubMed  Google Scholar 

  36. Bilous RW, Mauer SM, Sutherland DER, Steffes MW (1989) Mean glomerular volume and rate of development of diabetic nephropathy. Diabetes 38: 1142–1147

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Electron Microscopy Laboratory, Institute of Experimental Clinical Research, Institute of Pathology and Medical Department M, Aarhus Kommunehospital, DK-8000, Aarhus, Denmark

    R. Østerby & A. Schmitz

  2. Steno Diabetes Center, Gentofte, Denmark

    M. -A. Gall, F. S. Nielsen & H. -H. Parving

  3. Transplant Unit, Sahlgrenska Hospital, Göteborg, Sweden

    G. Nyberg

Authors
  1. R. Østerby
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. -A. Gall
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Schmitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. S. Nielsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Nyberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. -H. Parving
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Østerby, R., Gall, M.A., Schmitz, A. et al. Glomerular structure and function in proteinuric Type 2 (non-insulin-dependent) diabetic patients. Diabetologia 36, 1064–1070 (1993). https://doi.org/10.1007/BF02374500

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02374500

Key words

Search

Navigation