Journal of Pathology and Translational Medicine

Original Articles

The Morphologic Patterns of Diabetic Nephropathy in Koreans.: Si Hyong Jang, Moon Hyang Park; Korean J Pathol. 2009;43(1):36-42.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.1.36

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BACKGROUND
Diabetic nephropathy is the most common cause of end-stage renal disease and it has various pathologic features. We investigated the clinicopathologic differences between the histologic classes of diabetic nephropathy.
METHODS
A total of 46 patients with diabetic nephropathy were evaluated. Morphologically, the renal lesions were divided into three categories: class 1, diffuse or nodular glomerulosclerosis: class 2, vascular change without evidence of glomerulosclerosis: and class 3, non-diabetic renal disease superimposed on diabetic glomerulosclerosis. We evaluated the laboratory findings and the histologic findings, including mesangial expansion, interstitial fibrosis and inflammation, arteriolar hyalinosis and tubular atrophy.
RESULTS
The proportion of each class was 32 cases (70%), 4 cases (9%) and 10 cases (21%), respectively. The clinical and laboratory data showed no significant difference among the classes. For the groups of class 1, the group with nodular sclerosis showed a higher serum creatinine level than did the diffuse group (p=0.003). IgA nephropathy was the most common non-diabetic renal disease superimposed on diabetic glomerulosclerosis in our study.
CONCLUSIONS
The patients with nodular glomerulosclerosis presented with a more progressed clinicopathological features than did the patients with class 1 diffuse glomerulosclerosis. We also found 21% of all the patients with diabetic nephropathy had superimposed non-diabetic renal disease in a Korean population.

Citations

Citations to this article as recorded by

Renal biopsy pattern in diabetes mellitus patients and their correlation with clinical parameters
G. Singh, B. Naik, U. Singh, A. Modi, R. Dave
Nephrology (Saint-Petersburg).2023; 27(3): 53. CrossRef
Non-diabetic renal disease in Croatian patients with type 2 diabetes mellitus
Ivica Horvatic, Miroslav Tisljar, Patricia Kacinari, Ivana Matesic, Stela Bulimbasic, Danica Galesic Ljubanovic, Tina Katic, Darko Kristovic, Kresimir Galesic
Diabetes Research and Clinical Practice.2014; 104(3): 443. CrossRef
Clinical versus histological diagnosis of diabetic nephropathy--is renal biopsy required in type 2 diabetic patients with renal disease?
G. Biesenbach, G. Bodlaj, H. Pieringer, M. Sedlak
QJM.2011; 104(9): 771. CrossRef

Immunohistochemical Localization of Extracellular Matrix Components in Diabetic Nephropathy.: Seung Sam Paik, Moon Hyang Park; Korean J Pathol. 1997;31(5):427-435.

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Abstract PDF: Normal human glomerular basement membrane (GBM) and mesangial matrix (MM) contain several different basement membrane components in varying degrees. The characteristic morphological and ultrastructural changes in patients with diabetic nephropathy are the thickening of the GBM and the expansion of the MM. In order to investigate the changes of extracellular matrix components in diabetes, the immunohistochemical localization was performed in 17 cases with different degrees using antisera to human collagen types I, III, IV, VI, fibronectin, and laminin. The following results were obtained: 1. The reactivity for collagen IV was increased in expanded MM in the diffuse glomerulosclerosis (GS). With the progression to the nodule formation, collagen IV was prominently decreased in the peripheral area of the nodules. 2. Collagen VI was increased in GBM and MM in the diffuse GS, it was especially prominent in the expanded MM. With the progression to nodule formation, collagen VI was prominently increased in the periphery of the nodules. 3. Interstitial collagen I and III were not stained in many of the cases with the diffuse GS. With the progression to nodule formation, these were slightly expressed. A lamellar pattern of positive reaction was noted at the periphery of the late nodular lesions. 4. Fibronectin was increased in GBM & MM in the diffuse GS, it was especially intense in the MM. With the progression to the nodule formation, the reactivity of antibody to the fibronectin was decreased. 5. Laminin was weakly stained along the GBM & trace in the MM, but was not changed in the nodular GS. In summary, the expanded mesangial matrix in the diffuse GS showed a markedly increased staining for collagen IV, fibronectin and collagen VI. Less intense linear staining for collagen VI, fibronectin, laminin, collagen IV and collagen III was noted along the GBM. In the nodular GS, the composition of the early nodules resembled that of the diffuse GS. However, the late nodular lesion of the nodular GS revealed decreased reactivity for collagen IV and fibronectin at the periphery of the nodule, where collagen VI and interstitial collagen I and III were increased in laminated pattern.

Case Report

Emphysematous Pyelonephritis in Diabetic Nephropathy A report of two cases.: Jae Ho Han, Lucia Kim, Sung Eun Kim, Soon Won Hong, Hyeon Joo Jeong; Korean J Pathol. 1999;33(5):367-370.

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Abstract PDF: Diabetic nephropathy is characterized by one or a combination of the following lesions: (1) glomerular involvement with three distinctive patterns: diffuse glomerulosclerosis, nodular glomerulosclerosis, and exudative lesions; (2) arteriolo sclerosis; (3) urinary tract bacterial infection with pyelonephritis and sometimes emphysematous pyelonephritis. Emphysematous pyelonephritis is an uncommon life-threatening and acute suppurative infection of the kidney, and usually occurs in diabetic female patients. It is characterized by the production of intraparenchymal gas. Glucose fermentation has been considered the main cause of the gas formation. We presented two illustrative nephrectomy cases of emphysematous pyelonephritis in addition to the typical pathologic features of diabetic nephropathy.

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