Kidney Week

Abstract: SA-PO178

Similarity and Difference of Clinicopathological Features Between Diabetic Nephropathy and Hypertensive Nephrosclerosis: A Nationwide Kidney Biopsy Study in Japan

Session Information

• Diabetic Kidney Disease: Clinical - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Furuichi, Kengo, Kanazawa University, Kanazawa, Japan

Kengo Furuichi,

• Shimizu, Miho, Division of Nephrology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan

Miho Shimizu,

• Toyama, Tadashi, Kanazawa University Hospital, Kanazawa, Japan

Tadashi Toyama,

• Iwata, Yasunori, Kanazawa University, Kanazawa, Japan

Yasunori Iwata,

• Sakai, Norihiko, Kanazawa University, Kanazawa, Japan

Norihiko Sakai,

• Wada, Takashi, Kanazawa University, Kanazawa, Japan

Takashi Wada,

Background

Diabetic kidney disease is the major cause of end-stage kidney disease in developed countries. Moreover, hypertensive nephrosclerosis is increasing cause of end-stage kidney disease in Japan. In this study, we evaluated clinicopathological features between diabetic nephropathy and hypertensive nephrosclerosis using nationwide biopsy samples in Japan.

Methods

The clinical data of 600 biopsy-confirmed diabetic nephropathy patients and 184 biopsy-confirmed hypertensive nephrosclerosispatients were collected retrospectively from 13 centres throughout Japan under the support from the Japan Agency for Medical Research and Development. Pathological features and decreasing rate ofestimated GFR (eGFR) were evaluated between the two biopsy cohorts under the CKD heat map classification.

Results

The median observation period was 70.4 (IQR; 20.9-101.0) months in diabetic nephropathy and 73.2 (IQR; 31.2-116.4) months in hypertensive nephrosclerosis. In the CKD heat map categories, Green and Yellow (G&Y), Orange and Red category contained 103, 149, and 348 cases in diabetic nephropathy and 36, 57, and 91 cases in hypertensive nephrosclerosis, respectively. In clinical factors, body mass index, systolic and diastolic blood pressure were higher in patients with hypertensive nephrosclerosis than diabetic nephropathy in G&Y category. Declining speed of eGFR was no difference between two cohorts (diabetic nephropathy, hypertensive nephrosclerosis; 1.7, 2.4 mL/min/1.73 m²/year, respectively). However,there was no difference in pathological findings between two groups in the category.
In contrast to G&Y category, declining speed of eGFR was higher in patients with diabetic nephropathy than hypertensive nephrosclerosis in Red category (diabetic nephropathy, hypertensive nephrosclerosis; 5.8, 1.3 mL/min/1.73 m²/year, respectively). In accordance with the clinical findings, pathological findings of interstitial fibrosis and cell infiltration and arteriolar hyalinosis were progressed in diabetic nephropathy in Red category.

Conclusion

Although, it is so difficult to clearly distinguish pure kidney lesions caused by diabetes and hypertension, it would be important that these overlapped pathological findings be confirmed on kidney biopsy in diabetic cases with hypertension.

Funding

• Government Support - Non-U.S.