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- Title
Incidence and Significance of Mesangiolysis in Type II Diabetes -- A Clinico-Pathological Study on 217 Autopsies.
- Authors
Varga, I.; Schmidbauer, M.; Haas, C. S.; Reulbach, U.; Câmpean, V.; Gross, M. L.; Mall, G.; Amann, K.
- Abstract
Objective: Mesangiolysis is defined as dissolution of the mesangial matrix. It is described in several human glomerulopathies, i.e. diabetic and hypertensive nephropathy, as well as in various experimental models of renal disease. In diabetes mellitus nodular type glomerulosclerosis, i.e. the Kimmelstiel-Wilson lesion, is thought to result from mesangiolysis and formation of capillary aneurysms with subsequent thrombosis. However, the evidence supporting this hypothesis is still limited. Therefore, it was the aim of the present study to analyse the incidence and significance of mesangiolysis, i.e. capillary dilatation and aneurysm formation in type II diabetic nephropathy. Methods: From 217 consecutive patients with (176) or without (41) type II diabetes mellitus kidneys were harvested at autopsy and investigated using semiquantitative indices of mesangiolysis, glomerulosclerosis and glomerular nodulus formation. In addition, glomerular size was analysed using a semiautomatic image analysing system. 50 patients out of the 176 were classified into 5 groups according to their kidney function and compared to 10 control patients. The morphological findings were analysed with respect to renal function, duration of diabetes and other clinical data using multiple regression analysis. Results: In 48.8% of patients with type II diabetes nodular type glomerulosclerosis was present and the incidence of mesangiolysis was 18.4%. Glomerulosclerosis significantly increased with the duration of diabetes (p < 0.005) and was significantly correlation with creatinine clearance (p < 0.001). In addition, there was a highly significant correlation between the degree of mesangiolysis and the presence and size of glomerular noduli (p < 0.01). Moreover, nodular glomerulosclerosis was significantly correlated with creatinine clearance (p < 0.001), glomerular size (p < 0.01) and age of the patients (p < 0.05). Within the 5 groups the indices of mesangiolysis, noduli and glomerulosclerosis showed a steady increase in parallel with the increase in serum creatinine. In contrast, glomerular size which was in general significantly greater in diabetes compared to controls was not significantly different between the 5 diabetic groups. Conclusions: The present study presents a detailed analysis of the spectrum of morphological changes in type II diabetes in connection with the clinical findings. It provides further evidence for an association between mesangiolysis and nodular type glomerulosclerosis both of which are correlated with duration of diabetes and renal function.
- Subjects
DIABETIC nephropathies; KIDNEY diseases; ANEURYSMS; THROMBOSIS; AUTOPSY; DIABETES
- Publication
Kidney & Blood Pressure Research, 2004, Vol 27, Issue 5/6, p16
- ISSN
1420-4096
- Publication type
Article