Structural-Functional Relationships

Kidney International (1992) 41, 741–748; doi:10.1038/ki.1992.116

Glomerular structure in type-1 (insulin-dependent) diabetic patients with normo- and microalbuminuria

James D Walker, Collin F Close, Sharon L Jones, Martin Rafftery, Harry Keen, GianCarlo Viberti and Ruth Østerby

Units for Metabolic and Renal Medicine, UMDS, Guy's Hospital, London, England, United Kingdom; and Electron Microscopy Laboratory, Institute for Experimental Clinical Research, University Institute of Pathology, Kommunehospitalet, Aarhus, Denmark

Correspondence: Ruth Østerby MD, Electron Microscopy Laboratory, Institute of Pathology, Kommunehospitalet, DK-8000 Århus C, Denmark.

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Abstract

Glomerular structure in type-1 (insulin-dependent) diabetic patients with normo- and microalbuminuria. Kidney biopsies from 15 type-1 (insulin-dependent) diabetic patients with a range of albumin excretion (AER) were analyzed. Nine patients had normal AER, and six had microalbuminuria. Basement membrane thickness, BMT, and mesan-gial matrix volume fraction, Vv(mat/glom), were obtained from at least three glomeruli per biopsy. Mesangial structures were estimated with electron microscopic analysis at three levels in each glomerulus. Glomerulopathy parameters were significantly increased in micro-versus normoalbuminuric patients with the following means and (CV): BMT 571 nm (0.12) and 442 nm (0.25), = 0.03; Vv(mes/glom) 0.31 (0.20) and 0.22 (0.14), = 0.002; Vv(matrix/glom) 0.17 (0.25) and 0.11 (0.28), = 0.006; matrix star volume 56 3 (0.47) and 22 ^m3 (0.43), = 0.02. A positive correlation obtained between AER and each of the glomerulopathy parameters, BM thickness, Vv(mes/glom) and Vv(ma-trix/glom), as well as between AER and a structural index expressing the sum of changes in the peripheral BM and in the mesangium (r = 0.62, = 0.01). The results indicated a parallel course of mesangial and peripheral BM changes: a positive correlation obtained between BM thickness and mesangial parameters [BMT versus Vv(matrix/glom): r -0.82, = 0.0001] and the ratio of the two subsets of glomerular BM material (PBM:matrix) did not show significant difference between normo- and microalbuminuric groups. The data give strong support to the contention that the transition from normo- into the microalbuminuric phase is linked to progressing glomerulopathy.

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References

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