Nodular glomerular lesion: A later stage of diabetic nephropathy?

Abstract

Background Two typical pathological changes can develop in the type 2 diabetic nephropathy: one is diffuse glomerulosclerosis (DIF) and the other is nodular glomerular lesion (NOD). The aim of this study is to retrospectively investigate these two types of diabetic nephropathy and compare the characteristics of clinical findings and prognosis. Methods One hundred and twenty-four patients with biopsy-proven diabetic nephropathy, including 58 DIF and 66 NOD were investigated in this study. Clinical data were registered for each patient: age, sex, diabetes duration, hypertension duration, body mass index (BMI), and laboratory tests included: glycosylated hemoglobin, plasma albumin, plasma cholesterol and triglycerides, serum creatinine, proteinuria, urine osmole, urine N-acetyl-β- d-glucosaminidase (NAG) enzyme and creatinine clearance rate (Ccr). Furthermore, the 1- and 5-year renal survival rates were analysed and compared. Results (1) Compared with DIF patients, NOD patients had a longer duration of diabetic mellitus, and higher levels of proteinuria and NAG enzyme, along with lower BMI, Ccr and plasma albumin levels ( p < 0.01). (2) In the NOD cases, there were 90% presented diabetic retinopathy; while in the DIF cases, there were 14% presented diabetic retinopathy. (3) In the DIF patients, the 1- and 5-year renal survival rates were 96 and 78%, respectively, while in the NOD patients, the rates were 86 and 18%, respectively ( p < 0.01). Conclusion The NOD patients had longer diabetic durations, more severe renal damage, and exhibit a poorer renal prognosis. Furthermore, the NOD patients revealed more frequently evidence of diabetic retinopathy.