Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy

Melvin M. Schwartz; Edmund J. Lewis; Thomas Leonard-Martin; Julia Breyer Lewis; Daniel Batlle; Tomas Berl; William Hammond; Carl Becker; Samuel Blumenthal; Barbara Bresnah; Agnes B. Fogo; Julia Lewis; Gerald Schulman; Stephen Bonsib; Rebecca Hegeman; Lawrence G. Hunsicker; Andrew Levey; Angelo Ucci; Roger A. Rodby; Melvin Schwartz; Jonathon Myles; Raymond Tubbs; Marc A. Pohl; Paul Shanley; Nathan Tolchin; Daniel C. Batlle; Taha Keilani; Yashpal Kanwar; Max Mora; Jerome G. Porush; Samuel Spitalewitz; Praveen Chander; Kenneth Shapiro; Robert Toto; John Paul Middleton; Zeev Sharon; Barry J. Rosenbaum

doi:10.1093/ndt/13.10.2547

Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy

Melvin M. Schwartz, Edmund J. Lewis, Thomas Leonard-Martin, Julia Breyer Lewis, Daniel Batlle, Tomas Berl, William Hammond, Carl Becker, Samuel Blumenthal, Barbara Bresnah, Agnes B. Fogo, Julia Lewis, Gerald Schulman, Stephen Bonsib, Rebecca Hegeman, Lawrence G. Hunsicker, Andrew Levey, Angelo Ucci, Roger A. Rodby, Melvin SchwartzJonathon Myles, Raymond Tubbs, Marc A. Pohl, Paul Shanley, Nathan Tolchin, Daniel C. Batlle, Taha Keilani, Yashpal Kanwar, Max Mora, Jerome G. Porush, Samuel Spitalewitz, Praveen Chander, Kenneth Shapiro, Robert Toto, John Paul Middleton, Zeev Sharon, Barry J. Rosenbaum

Research output: Contribution to journal › Article › peer-review

146 Scopus citations

Abstract

Background. The glomerular and retinal vessels are both affected in patients with type I and type II diabetes mellitus. However, the prevalence of the nodular form of diabetic glomerular sclerosis (Kimmelstiel-Wilson lesion) and other forms of glomerular pathology including diffuse mesangial sclerosis and their clinical correlates in type II diabetes are less well known. In addition, although recent studies have suggested that non-diabetic glomerular disease was a common cause of proteinuria in type II diabetes, the prevalence of other diseases is unknown. The literature on this subject is clouded by clinical bias regarding patients with diabetes who undergo renal biopsy. Methods. Glomerular and retinal pathology and clinical correlates were studied in 36 patients enrolled in a prospective clinical trial of patients with type II diabetes mellitus, proteinuria, renal insufficiency, and hypertension. Results. Seventeen biopsies had diabetic glomerular sclerosis with Kimmelstiel-Wilson nodules; 15 biopsies had glomerular changes characteristic of the diabetic state including enlarged glomeruli and an increase in mesangial matrix without Kimmelstiel-Wilson nodules (mesangial sclerosis lesion); and two had other primary glomerular diseases (IgA and membranous nephropathy). Patients with Kimmelstiel-Wilson nodules had elevated serum creatinines compared to patients with mesangial sclerosis lesions, but there were no other significant differences. Patients with Kimmelstiel-Wilson nodules had more severe overall retinopathy than those with mesangial sclerosis lesions (P = 0.0043): six of seven with proliferative retinopathy had Kimmelstiel-Wilson nodules, and seven of the eight patients without retinopathy had mesangial sclerosis lesions. Conclusions. The two discrete patterns of glomerular pathology and the correlation between diabetic retinopathy and the Kimmelstiel-Wilson lesion but not the mesangial sclerosis lesion suggest that the Kimmelstiel-Wilson and mesangial sclerosis lesions of diabetic glomerulosclerosis are caused by different pathogenetic mechanisms. In this study, diabetic glomerulosclerosis was responsible for the clinical renal abnormalities in 94% of patients with type II diabetes mellitus.

Original language	English (US)
Pages (from-to)	2547-2552
Number of pages	6
Journal	Nephrology Dialysis Transplantation
Volume	13
Issue number	10
DOIs	https://doi.org/10.1093/ndt/13.10.2547
State	Published - Oct 1998

Keywords

Diabetes mellitus
Glomerulopathy
Kimmelstiel-Wilson
Renal failure
Retinopathy
Type II

ASJC Scopus subject areas

Nephrology
Transplantation

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10.1093/ndt/13.10.2547

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Schwartz, M. M., Lewis, E. J., Leonard-Martin, T., Lewis, J. B., Batlle, D., Berl, T., Hammond, W., Becker, C., Blumenthal, S., Bresnah, B., Fogo, A. B., Lewis, J., Schulman, G., Bonsib, S., Hegeman, R., Hunsicker, L. G., Levey, A., Ucci, A., Rodby, R. A., ... Rosenbaum, B. J. (1998). Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrology Dialysis Transplantation, 13(10), 2547-2552. https://doi.org/10.1093/ndt/13.10.2547

Schwartz, MM, Lewis, EJ, Leonard-Martin, T, Lewis, JB, Batlle, D, Berl, T, Hammond, W, Becker, C, Blumenthal, S, Bresnah, B, Fogo, AB, Lewis, J, Schulman, G, Bonsib, S, Hegeman, R, Hunsicker, LG, Levey, A, Ucci, A, Rodby, RA, Schwartz, M, Myles, J, Tubbs, R, Pohl, MA, Shanley, P, Tolchin, N, Batlle, DC, Keilani, T, Kanwar, Y, Mora, M, Porush, JG, Spitalewitz, S, Chander, P, Shapiro, K, Toto, R, Middleton, JP, Sharon, Z & Rosenbaum, BJ 1998, 'Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy', Nephrology Dialysis Transplantation, vol. 13, no. 10, pp. 2547-2552. https://doi.org/10.1093/ndt/13.10.2547

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title = "Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy",

abstract = "Background. The glomerular and retinal vessels are both affected in patients with type I and type II diabetes mellitus. However, the prevalence of the nodular form of diabetic glomerular sclerosis (Kimmelstiel-Wilson lesion) and other forms of glomerular pathology including diffuse mesangial sclerosis and their clinical correlates in type II diabetes are less well known. In addition, although recent studies have suggested that non-diabetic glomerular disease was a common cause of proteinuria in type II diabetes, the prevalence of other diseases is unknown. The literature on this subject is clouded by clinical bias regarding patients with diabetes who undergo renal biopsy. Methods. Glomerular and retinal pathology and clinical correlates were studied in 36 patients enrolled in a prospective clinical trial of patients with type II diabetes mellitus, proteinuria, renal insufficiency, and hypertension. Results. Seventeen biopsies had diabetic glomerular sclerosis with Kimmelstiel-Wilson nodules; 15 biopsies had glomerular changes characteristic of the diabetic state including enlarged glomeruli and an increase in mesangial matrix without Kimmelstiel-Wilson nodules (mesangial sclerosis lesion); and two had other primary glomerular diseases (IgA and membranous nephropathy). Patients with Kimmelstiel-Wilson nodules had elevated serum creatinines compared to patients with mesangial sclerosis lesions, but there were no other significant differences. Patients with Kimmelstiel-Wilson nodules had more severe overall retinopathy than those with mesangial sclerosis lesions (P = 0.0043): six of seven with proliferative retinopathy had Kimmelstiel-Wilson nodules, and seven of the eight patients without retinopathy had mesangial sclerosis lesions. Conclusions. The two discrete patterns of glomerular pathology and the correlation between diabetic retinopathy and the Kimmelstiel-Wilson lesion but not the mesangial sclerosis lesion suggest that the Kimmelstiel-Wilson and mesangial sclerosis lesions of diabetic glomerulosclerosis are caused by different pathogenetic mechanisms. In this study, diabetic glomerulosclerosis was responsible for the clinical renal abnormalities in 94% of patients with type II diabetes mellitus.",

keywords = "Diabetes mellitus, Glomerulopathy, Kimmelstiel-Wilson, Renal failure, Retinopathy, Type II",

author = "Schwartz, {Melvin M.} and Lewis, {Edmund J.} and Thomas Leonard-Martin and Lewis, {Julia Breyer} and Daniel Batlle and Tomas Berl and William Hammond and Carl Becker and Samuel Blumenthal and Barbara Bresnah and Fogo, {Agnes B.} and Julia Lewis and Gerald Schulman and Stephen Bonsib and Rebecca Hegeman and Hunsicker, {Lawrence G.} and Andrew Levey and Angelo Ucci and Rodby, {Roger A.} and Melvin Schwartz and Jonathon Myles and Raymond Tubbs and Pohl, {Marc A.} and Paul Shanley and Nathan Tolchin and Batlle, {Daniel C.} and Taha Keilani and Yashpal Kanwar and Max Mora and Porush, {Jerome G.} and Samuel Spitalewitz and Praveen Chander and Kenneth Shapiro and Robert Toto and Middleton, {John Paul} and Zeev Sharon and Rosenbaum, {Barry J.}",

year = "1998",

month = oct,

doi = "10.1093/ndt/13.10.2547",

language = "English (US)",

volume = "13",

pages = "2547--2552",

journal = "Nephrology Dialysis Transplantation",

issn = "0931-0509",

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TY - JOUR

T1 - Renal pathology patterns in type II diabetes mellitus

T2 - Relationship with retinopathy

AU - Schwartz, Melvin M.

AU - Lewis, Edmund J.

AU - Leonard-Martin, Thomas

AU - Lewis, Julia Breyer

AU - Batlle, Daniel

AU - Berl, Tomas

AU - Hammond, William

AU - Becker, Carl

AU - Blumenthal, Samuel

AU - Bresnah, Barbara

AU - Fogo, Agnes B.

AU - Lewis, Julia

AU - Schulman, Gerald

AU - Bonsib, Stephen

AU - Hegeman, Rebecca

AU - Hunsicker, Lawrence G.

AU - Levey, Andrew

AU - Ucci, Angelo

AU - Rodby, Roger A.

AU - Schwartz, Melvin

AU - Myles, Jonathon

AU - Tubbs, Raymond

AU - Pohl, Marc A.

AU - Shanley, Paul

AU - Tolchin, Nathan

AU - Batlle, Daniel C.

AU - Keilani, Taha

AU - Kanwar, Yashpal

AU - Mora, Max

AU - Porush, Jerome G.

AU - Spitalewitz, Samuel

AU - Chander, Praveen

AU - Shapiro, Kenneth

AU - Toto, Robert

AU - Middleton, John Paul

AU - Sharon, Zeev

AU - Rosenbaum, Barry J.

PY - 1998/10

Y1 - 1998/10

N2 - Background. The glomerular and retinal vessels are both affected in patients with type I and type II diabetes mellitus. However, the prevalence of the nodular form of diabetic glomerular sclerosis (Kimmelstiel-Wilson lesion) and other forms of glomerular pathology including diffuse mesangial sclerosis and their clinical correlates in type II diabetes are less well known. In addition, although recent studies have suggested that non-diabetic glomerular disease was a common cause of proteinuria in type II diabetes, the prevalence of other diseases is unknown. The literature on this subject is clouded by clinical bias regarding patients with diabetes who undergo renal biopsy. Methods. Glomerular and retinal pathology and clinical correlates were studied in 36 patients enrolled in a prospective clinical trial of patients with type II diabetes mellitus, proteinuria, renal insufficiency, and hypertension. Results. Seventeen biopsies had diabetic glomerular sclerosis with Kimmelstiel-Wilson nodules; 15 biopsies had glomerular changes characteristic of the diabetic state including enlarged glomeruli and an increase in mesangial matrix without Kimmelstiel-Wilson nodules (mesangial sclerosis lesion); and two had other primary glomerular diseases (IgA and membranous nephropathy). Patients with Kimmelstiel-Wilson nodules had elevated serum creatinines compared to patients with mesangial sclerosis lesions, but there were no other significant differences. Patients with Kimmelstiel-Wilson nodules had more severe overall retinopathy than those with mesangial sclerosis lesions (P = 0.0043): six of seven with proliferative retinopathy had Kimmelstiel-Wilson nodules, and seven of the eight patients without retinopathy had mesangial sclerosis lesions. Conclusions. The two discrete patterns of glomerular pathology and the correlation between diabetic retinopathy and the Kimmelstiel-Wilson lesion but not the mesangial sclerosis lesion suggest that the Kimmelstiel-Wilson and mesangial sclerosis lesions of diabetic glomerulosclerosis are caused by different pathogenetic mechanisms. In this study, diabetic glomerulosclerosis was responsible for the clinical renal abnormalities in 94% of patients with type II diabetes mellitus.

AB - Background. The glomerular and retinal vessels are both affected in patients with type I and type II diabetes mellitus. However, the prevalence of the nodular form of diabetic glomerular sclerosis (Kimmelstiel-Wilson lesion) and other forms of glomerular pathology including diffuse mesangial sclerosis and their clinical correlates in type II diabetes are less well known. In addition, although recent studies have suggested that non-diabetic glomerular disease was a common cause of proteinuria in type II diabetes, the prevalence of other diseases is unknown. The literature on this subject is clouded by clinical bias regarding patients with diabetes who undergo renal biopsy. Methods. Glomerular and retinal pathology and clinical correlates were studied in 36 patients enrolled in a prospective clinical trial of patients with type II diabetes mellitus, proteinuria, renal insufficiency, and hypertension. Results. Seventeen biopsies had diabetic glomerular sclerosis with Kimmelstiel-Wilson nodules; 15 biopsies had glomerular changes characteristic of the diabetic state including enlarged glomeruli and an increase in mesangial matrix without Kimmelstiel-Wilson nodules (mesangial sclerosis lesion); and two had other primary glomerular diseases (IgA and membranous nephropathy). Patients with Kimmelstiel-Wilson nodules had elevated serum creatinines compared to patients with mesangial sclerosis lesions, but there were no other significant differences. Patients with Kimmelstiel-Wilson nodules had more severe overall retinopathy than those with mesangial sclerosis lesions (P = 0.0043): six of seven with proliferative retinopathy had Kimmelstiel-Wilson nodules, and seven of the eight patients without retinopathy had mesangial sclerosis lesions. Conclusions. The two discrete patterns of glomerular pathology and the correlation between diabetic retinopathy and the Kimmelstiel-Wilson lesion but not the mesangial sclerosis lesion suggest that the Kimmelstiel-Wilson and mesangial sclerosis lesions of diabetic glomerulosclerosis are caused by different pathogenetic mechanisms. In this study, diabetic glomerulosclerosis was responsible for the clinical renal abnormalities in 94% of patients with type II diabetes mellitus.

KW - Diabetes mellitus

KW - Glomerulopathy

KW - Kimmelstiel-Wilson

KW - Renal failure

KW - Retinopathy

KW - Type II

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Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy

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