RT Journal Article SR Electronic T1 Clinicopathological features of fast eGFR decliners among patients with diabetic nephropathy JF BMJ Open Diabetes Research & Care JO BMJ Open Diab Res Care FD American Diabetes Association SP e001157 DO 10.1136/bmjdrc-2019-001157 VO 8 IS 1 A1 Kengo Furuichi A1 Miho Shimizu A1 Masayuki Yamanouchi A1 Junichi Hoshino A1 Norihiko Sakai A1 Yasunori Iwata A1 Tadashi Toyama A1 Shinji Kitajima A1 Akinori Hara A1 Yukio Yuzawa A1 Hiroshi Kitamura A1 Yoshiki Suzuki A1 Hiroshi Sato A1 Noriko Uesugi A1 Yoshihiko Ueda A1 Shinichi Nishi A1 Tomoya Nishino A1 Kenichi Samejima A1 Kentaro Kohagura A1 Yugo Shibagaki A1 Hirofumi Makino A1 Seiichi Matsuo A1 Yoshifumi Ubara A1 Hitoshi Yokoyama A1 Takashi Wada YR 2020 UL http://drc.bmj.com/content/8/1/e001157.abstract AB Introduction The speed of declining kidney function differs among patients with diabetic nephropathy. This study was undertaken to clarify clinical and pathological features that affect the speed of declining kidney function in patients with diabetic nephropathy.Research design and methods This study was design as multicenter retrospective study. The subjects (377 patients with diabetic nephropathy diagnosed by kidney biopsy at 13 centers in Japan) were classified into three groups based on the estimated glomerular filtration rate (eGFR) declining speed. The eGFR increasing group, the control group, and the eGFR declining group were divided at 0 and 5 mL/min/1.73 m2/year, respectively. Characteristics of clinicopathological findings of declining kidney function were evaluated.Results The mean observation period of this study was 6.9 years. The control group, the eGFR increasing group, and the eGFR declining group included 81, 66, and 230 patients, respectively. The incidences of composite kidney events represented by 100 persons/year were 25.8 in the eGFR declining group and 2.0 in the eGFR increasing group. After adjustment for age, sex, systolic blood pressure, hemoglobin, and urinary albumin levels, three clinicopathological findings (urinary albumin levels, presence of nodular lesion, and mesangiolysis) were risk factors for inclusion in the eGFR declining group (the ORs were 1.49, 2.18, and 2.08, respectively). In contrast, the presence of subendothelial space widening and polar vasculosis were characteristic findings for inclusion in the eGFR increasing group (the ORs were 0.53 and 0.41, respectively).Conclusions As well as urinary albumin elevation, nodular lesion and mesangiolysis were characteristic pathological features of patients with fast declining kidney function.