Morphological Changes of Platelets as a Marker of Early Progression of Diabetic Nephropathy

Abstract

Aim: To study the main morphological changes of platelets in patients with type 1 diabetes mellitus (T1DM) depending on the level of estimated glomerular filtration rate (eGFR). Materials and Methods: The study involved 37 patients with T1DM. Patients were divided to groups according to the level of eGFR (CKD-EPI, ml/min/1.73m²). Group 1 had eGFR ≥90; group 2 - eGFR 89-60; group 3 - eGFR 59-45. Control group consists of 10 healthy people. All patients were comparable for age and sex. The relative content of unactivated, aggregated, degranulated platelets and the density of packaging of α-granules in the platelet were determined using a transmission electron microscope120kV TEMs (JEOL USA). Results: Changes were found in all three groups compared to the control. Decrease of unactivated platelets (%) 69.7 (62.4; 77), 64.6 (55.5, 73.7), 47.8 (39.6, 56.0), 75.5 (66.2; 84.8), respectively; increase of aggregated platelets (%) 7.4 (6.58; 8.22), 10.6 (9.4; 11.8), 15.4 (14.3; 16.5), 6.8 (5.98; 7.62), respectively; increase of degranulated platelets (%) 7.2 (6.22; 8.18), 10.4 (9.53; 11.27), 21.0 (18.88; 22.12), 6.3 (5.2; 7.4), respectively; decrease of the density of packaging of α-granules in the platelet (mkm³/mkm³) 0.0962 (0.0632; 0.0994); 0.093 (0.06; 0.126), 0.067 (0.038; 0.096), 0.1(0.077; 0.139), respectively. In the study group revealed a direct correlation between eGFR and: unactivated platelets (ρ=0.77; p<0.001), density packing of α-granules (ρ=0.55; p <0.001); the inverse correlation between eGFR and: aggregated platelets (ρ=-0.63; p<0.001), degranulated platelets (ρ=-0.72; p<0.001). Conclusions: Morphological substrate of platelets damage is a complex of ultrastructural changes, which is an early predictor of the development of vascular complications. Morphological changes of platelets are detected with stored eGFR. Stronger changes correspond to low eGFR, that gives us to consider a complex of ultrastructural platelets changes, as an early sign of diabetic nephropathy. Disclosure N. Pertseva: None. C. Daria: None. T. Igor: None.