Changes in Albuminuria But Not GFR are Associated with Early Changes in Kidney Structure in Type 2 Diabetes
| العنوان: | Changes in Albuminuria But Not GFR are Associated with Early Changes in Kidney Structure in Type 2 Diabetes |
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| المؤلفون: | Behzad Najafian, Helen C. Looker, Robert G. Nelson, Cordell A. Esplin, Paolo Guarnieri, Jennifer L. Harder, Michael Mauer, Jon Hill, Carine M. Boustany-Kari, Matthias Kretzler, Pierre Jean Saulnier, Viji Nair |
| المصدر: | J Am Soc Nephrol |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Time Factors, Urinary system, 030232 urology & nephrology, Urology, Type 2 diabetes, 030204 cardiovascular system & hematology, Kidney Function Tests, urologic and male genital diseases, Losartan, Diabetic nephropathy, 03 medical and health sciences, 0302 clinical medicine, Biopsy, Albuminuria, Humans, Medicine, Diabetic Nephropathies, Clinical Epidemiology, skin and connective tissue diseases, Analysis of Variance, Kidney, Type 1 diabetes, medicine.diagnostic_test, urogenital system, business.industry, Glomerular basement membrane, Biopsy, Needle, General Medicine, Middle Aged, medicine.disease, Immunohistochemistry, female genital diseases and pregnancy complications, medicine.anatomical_structure, Diabetes Mellitus, Type 2, Nephrology, Disease Progression, Indians, North American, Linear Models, Female, medicine.symptom, business, Glomerular Filtration Rate |
| الوصف: | Background In type 1 diabetes, changes in the GFR and urine albumin-to-creatinine ratio (ACR) are related to changes in kidney structure that reflect disease progression. However, such changes have not been studied in type 2 diabetes. Methods Participants were American Indians with type 2 diabetes enrolled in a clinical trial of losartan versus placebo. We followed a subset who underwent kidney biopsy at the end of the 6-year trial, with annual measurements of GFR (by urinary clearance of iothalamate) and ACR. Participants had a second kidney biopsy after a mean follow-up of 9.3 years. We used quantitative morphometric analyses to evaluate both biopsy specimens. Results Baseline measures for 48 participants (12 men and 36 women, mean age 45.6 years) who completed the study included diabetes duration (14.6 years), GFR (156 ml/min), and ACR (15 mg/g). During follow-up, glomerular basement membrane (GBM) width, mesangial fractional volume, and ACR increased, and surface density of peripheral GBM and GFR decreased. After adjustment for sex, age, ACR, and each morphometric variable at baseline, an increase in ACR during follow-up was significantly associated with increases in GBM width, mesangial fractional volume, and mean glomerular volume, and a decrease in surface density of peripheral GBM. Decline in GFR was not associated with changes in these morphometric variables after additionally adjusting for baseline GFR. Conclusions In American Indians with type 2 diabetes and preserved GFR at baseline, increasing ACR reflects the progression of earlier structural glomerular lesions, whereas early GFR decline may not accurately reflect such lesions. |
| تدمد: | 1533-3450 1046-6673 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c4fa5eeb94b5df3d129d08ca0c3bc26bTest https://doi.org/10.1681/asn.2018111166Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....c4fa5eeb94b5df3d129d08ca0c3bc26b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15333450 10466673 |
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