RENAL HISTOLOGY IN TYPE 2 DIABETES MELLITUS : CLINICOPATHOLOGIC CORRELATION IN 301 PATIENTS

Renal pathologic features in type 2 diabetes and their correlation with clinical manifestations are incompletely known. Renal biopsy specimens from 301 patients were analyzed retrospectively. Light microscopic findings were graded by Gellman's criteria for diffuse glomerular lesions, which included 44 cases in grade D0, 81 in D1, 98 in D2, 49 in D3, and 29 in D4. Amounts of albuminuria or proteinuria correlated significantly with the grade of diffuse glomerular lesions, as did serum creatinine concentration. Creatinine clearance decreased significantly with increasing severity of glomerular lesions. This evidence strongly supports a close relationship between structural changes and functional abnormalities in diabetic nephropathy

TUBULOINTERSTITIAL LESIONS IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES MELLITUS AND DECLINE IN GLOMERULAR FILTRATION RATE

To evaluate the role of tubulointerstitial lesions in diabetic nephropathy, we studied the renal histological findings and various functional parameters in 201 patients with non-insulin-dependent diabetes mellitus (NIDDM). The patients were divided into four groups according to the severity of the tubulointerstitial lesions on a scale of T0 through TⅢ. Diffuse glomerular lesions were graded by Gellman's criteria (D0 through DⅣ). There was a weak correlation between the severity of glomerular diffuse lesions and that of tubulointerstitial lesions ; discordance between glomerular and tubulointerstitial lesions was presest in 37 patients (18%). Urinary excretion of β₂ MG and NAG significantly increased with the severity of tubulointerstitial lesions, whereas the creatinine clearance decreased. Multiple regression analysis showed that glomerular and tubulbinterstitial lesions independently contribute to the decline of the glomerular filtration rate. These results suggest that tubulointerstitial lesions are involved in the progression of diabetic nephropathy

IMMUNOGLOBULIN A NEPHROPATHY ASSOCIATED WITH DIABETES MELLITUS : A SUMMARY OF 10 CASES AND REVIEW OF LITERATURE

Case reports of 10 patients with IgA nephropathy associated with diabetes mellitus are presented. The clinical characteristics of each of the patients are summarized. We determined the incidence of IgA nephropathy in a total of 313 patients with diabetes mellitus who underwent renal biopsy between 1982 and 1996 : it was 3.2% for the group of all diabetic patients, and 10.8% for diabetic patients with overt proteinuria. Clinicopath- ologic features of IgA nephropathy observed in diabetic patients are discussed in the context of a review of the literature

A CASE OF FOCAL GLOMERULOSCLEROSIS ASSOCIATED WITH CYSTINURIA

We report a case of cystinuria in which the nephrotic syndrome developed during treatment with tiopronin (alpha-mercaptopropionylglycine). Light microscopy of renal biopsy specimen showed focal glomerulosclerosis. Proteinuria resolved after withdrawal of the drug and without corticosteroid administration. The pathogenesis of tiopronin-induced nephropathy and this unusual presentation of symptoms are discussed with respect to the literature

HYPOURICEMIA IN HOSPITALIZED DIABETIC PATIENTS

To determine the incidepce and clinicopathological characteristics of hypouricemia in patients with diabetes mellitus, we studied 473 consecutive hospitalized diabetic patients. The incidence of hypouricemia, defined as a serum urate concentration below 2.0 mg/dl, was 1.9% (9 patients). In this group (2 males, 7 females), there were no patients receiving drugs known to reduce serum urate concentration. Two of the 9 patients had neoplastic disease, while the others suffered from no other disorder known to affect serum urate levels. Four patients exhibited glomerular hyperfiltration. Three of the 9 patients were studied in more detail by renal biopsy, and all had mild to moderate glomerular diffuse lesions and tubulointerstitial lesions, such as interstitial fibrosis or mononuclear cell infiltration. These findings suggest that the glomerular hyperfiltration which accompanies diabetic nephropathy and functional abnormality of tubular urate handling due to tubulointerstitial involvement contribute to hypouricemia in diabetic patients

PRIMARY SYSTEMIC AMYLOIDOSIS PRESENTING WITH SEVERE HYPERLIPIDEMIA : A CASE REPORT

Primary systemic amyloidosis with severe hyperlipidemia, suspected to be secondary to hepatic involvement, is described. A 48-year-old man was admitted with pretibial edema and abdominal fullness. Laboratory data showed severe hyperlipidemia with lipoprotein X and nephrotic syndrome. Based on biopsy findings of the kidney and liver, he was diagnosed with primary systemic amyloidosis. Hyperlipidemia in this patient was too severe to result only from nephrotic syndrome. Moreover, with lipoprotein X present, we suggest that hepatic amyloidosis can be a cause of severe hyperlipidemia in primary systemic amyloidosis

RENOVASCULAR HYPERTENSION AND ERECTILE DYSFUNCTION SECONDARY TO POLYARTERITIS NODOSA : A CASE REPORT

We describe a patient with secondary hypertension and erectile dysfunction due to polyarteritis nodosa. A 30-year-old man was admitted because of hypertension and impotence. Blood pressure was 156/94 mm Hg, and was similar in both arms. Superficial sensation was diminished in the soles of the feet. Plasma renin activity was elevated. Intra-arterial digital subtraction angiography (DSA) of the renal arteries showed bilateral multiple microaneurysms in peripheral arterial branches between the interlobular and arcuate arteries of both kidneys. DSA of the internal iliac artery, the internal pudendal artery, and the hepatic artery also showed multiple microaneurysms, as well as focal stenoses. A diagnosis of organic (vascular) erectile dysfunction was made based on findings by the Rigi-scan (Dacomed Inc.). The patient, then, had polyarteritis nodosa presenting hypertension and erectile dysfunction

MEMBRANOUS NEPHROPATHY ASSOCIATED WITH DIABETES MELLITUS : REPORT OF FOUR CASES AND REVIEW OF LITERATURE

Case reports of 4 patients with membranous nephropathy (MN) associated with diabetes mellitus are presented. The clinical characteristics of each of the patients differed. We determined the incidence of MN in a total of 292 patients with diabetes mellitus who underwent renal biopsy between 1982 and 1995 : it was 1.4% for the group of all patients, and 4.8% for patients with overt proteinuria. Clinicopathologic features of MN observed in diabetic patients are discussed in the context of a review of the literature

RUPTURED SINUS OF VALSALVA ANEURYSM IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

We report the case of a 57-year-old woman with systemic lupus erythematosus associated with a ruptured sinus of Valsalva aneurysm. The physical examination showed a holosystolic murmur at the left fourth intercostal space. Aortography revealed that the sinus of Valsalva aneurysm had ruptured into the right ventricle. Surgical closure of the ruptured aneurysm was successfully carried out. This aneurysm and its rupture may have been due to endocarditis involving the sinus of Valsalva

腎細動脈のヒアリノーシスは、大動脈の内膜肥厚とは異なり、腎生検で証明された糖尿病性腎症患者の心血管イベントに関連する。

Aims: Diabetic nephropathy, a pathologically diagnosed microvascular complication of diabetes, is a strong risk factor for cardiovascular events, which mainly involve arteries larger than those affected in diabetic nephropathy. However, the association between diabetic nephropathy pathological findings and cardiovascular events has not been well studied. We aimed to investigate whether the pathological findings in diabetic nephropathy are closely associated with cardiovascular event development. Methods: This retrospective cohort study analysed 377 people with type 2 diabetes and biopsy‐proven diabetic nephropathy, with a median follow‐up of 5.9 years (interquartile range 2.0 to 13.5). We investigated how cardiovascular events were impacted by two vascular diabetic nephropathy lesions, namely arteriolar hyalinosis and arterial intimal thickening, and by glomerular and interstitial lesions. Results: Of the 377 people with diabetic nephropathy, 331 (88%) and 295 (78%) had arteriolar hyalinosis and arterial intimal thickening, respectively. During the entire follow‐up period, those with arteriolar hyalinosis had higher cardiovascular event rates in the crude Kaplan–Meier analysis than those without these lesions (P = 0.005, log‐rank test). When fully adjusted for clinically relevant confounders, arteriolar hyalinosis independently predicted cardiovascular events [hazard ratio (HR) 1.99; 95% confidence interval (CI) 1.12, 3.86], but we did not find any relationship between arterial intimal thickening and cardiovascular events (HR 0.89; 95% CI 0.60, 1.37). Additionally, neither glomerular nor interstitial lesions were independently associated with cardiovascular events in the fully adjusted model. Conclusions: Arteriolar hyalinosis, but not intimal thickening of large arteries, was strongly associated with cardiovascular events in people with diabetic nephropathy.博士（医学）・乙第1464号・令和2年9月30日© 2020 Diabetes UKThis is the peer reviewed version of the following article: [https://onlinelibrary.wiley.com/doi/10.1111/dme.14301], which has been published in final form at [https://doi.org/10.1111/dme.14301]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions