Kidney Week

Abstract: SA-PO301

Enlarged Kidney Parenchymal Volume Predicts Poor Kidney Outcomes in Advanced Stage Diabetic Nephropathy

Session Information

• Diabetic Kidney Disease: Clinical Pathology, Diagnostic and Treatment Advances
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 702 Diabetic Kidney Disease: Clinical

Authors

• Miura, Akane, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan

Akane Miura, MD

• Okabe, Masahiro, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan

Masahiro Okabe, MD, PhD

• Sasaki, Takaya, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan

Takaya Sasaki, MD

• Okabayashi, Yusuke, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan

Yusuke Okabayashi, MD, PhD

• Haruhara, Kotaro, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan

Kotaro Haruhara, MD, PhD

• Tsuboi, Nobuo, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan

Nobuo Tsuboi, MD, PhD, FASN

• Yokoo, Takashi, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan

Takashi Yokoo, MD, PhD

Group or Team Name

• Dept of Nephrology and Hypertension, The Jikei University School of Medicine.

Background

Early diabetic nephropathy (DN) is characterized by enlarged kidneys, but its clinical significance in advanced stages is not well understood. This study aimed to determine whether total kidney parenchymal volume (V_TKP) is associated with renal outcomes in advanced stage DN patients with overt proteinuria.

Methods

V_TKP was estimated in biopsy-proven DN patients using unenhanced computed tomography imaging. Clinicopathological findings, kidney morphometric parameters and renal outcomes were compared among tertile groups based on V_TKP. The end point was defined as a 50% reduction in eGFR or ESKD.

Results

A total 81 patients were included in this study (84% male, median 55 years, eGFR 38 [24-52] ml/min/1.73m², urinary protein 4.4 [2.2-7.0] g/day and median 1.8-year follow-up). Median values of V_TKP were 111 [98-121], 156 [149-164], and 214 [191-243] cm³/kidney in the low, intermediate, and high V_TKP groups. There were no differences in sex, hypertension, HbA1c and BMI among groups. Age showed a decreasing trend, while eGFR and proteinuria showed an increasing trend with V_TKP. In the log-rank trend test, greater V_TKP was significantly associated with poor renal outcomes (Figure). Interestingly, the associations between V_TKP and renal outcomes were independent of age, eGFR and proteinuria levels at presentation (Table).

Conclusion

In patients with advanced stage DN, greater V_TKP at presentation is associated with poor renal outcomes, independent of kidney function and proteinuria levels.

Cox proportional hazard model

eGFR ≥50% decline or ESKD