Elif I. Ekinci, P.H.D., George Jerums, M.D., Alison Skene, M.B.B.S., Paul Crammer, B.A.P.P.S.C., David Power, P.H.D., Karey Y. Cheong, B.S.C., Sianna Panagiotopoulos, P.H.D., Karen McNeil, M.B.B.S., Scott T. Baker, M.B.B.S., Paola Fioretto, M.D., Richard

1
Elif I. Ekinci, P.H.D., George Jerums, M.D.,
Alison Skene, M.B.B.S., Paul Crammer,
B.A.P.P.S.C., David Power, P.H.D., Karey Y.
Cheong, B.S.C., Sianna Panagiotopoulos, P.H.D.,
Karen McNeil, M.B.B.S., Scott T. Baker, M.B.B.S.,
Paola Fioretto, M.D., Richard J. MacIsaac,
P.H.D.,
Diabetes Care Volume 36 3620-3626 November, 2013
2
STUDY OBJECTIVE  

• To compare renal biopsy findings in patients with
  type 2 diabetes and estimated glomerular
  filtration rate (eGFR) and measure GFR of lt60
  mL/min/1.73 m2, associated with normo-, micro-,
  or macroalbuminuria

Ekinci E. I. et al. Diabetes Care
2013363620-3626
3
STUDY DESIGN AND METHODS

• In patients with normo- or microalbuminuria,
  renal biopsies were performed according to a
  research protocol
• In patients with macroalbuminuria, biopsies were
  performed according to clinical indication
• Findings were categorized according to the
  Fioretto classification
• Category 1 (C1) normal/near normal
• Category 2 (C2) typical diabetic nephropathy
  (DN) with predominantly glomerular changes
• Category 3 (C3) atypical with
  disproportionately severe interstitial/tubular/vas
  cular damage and with no/mild diabetic glomerular
  changes

Ekinci E. I. et al. Diabetes Care
2013363620-3626
4
Ekinci E. I. et al. Diabetes Care
2013363620-3626
5
Ekinci E. I. et al. Diabetes Care
2013363620-3626
6
Ekinci E. I. et al. Diabetes Care
2013363620-3626
7
RESULTS

• Typical glomerular changes (C2) of DN were
  observed in 22 of 23 subjects with micro- or
  macroalbuminuria compared with 3 of 8 subjects
  with normoalbuminuria
• Predominantly interstitial or vascular changes
  (C3) were seen in only 1 of 23 subjects with
  micro- or macroalbuminuria compared with 3 of 8
  normoalbuminuric subjects
• Mesangial area increased progressively from
  normal controls to patients with type 2 diabetes
  and normo-, micro-, and macroalbuminuria
• Varying degrees of arteriosclerosis were seen in
  seven of eight subjects with normoalbuminuria

Ekinci E. I. et al. Diabetes Care
2013363620-3626
8
Ekinci E. I. et al. Diabetes Care
2013363620-3626
9
Ekinci E. I. et al. Diabetes Care
2013363620-3626
10
CONCLUSIONS

• Typical renal structural changes of DN were
  observed in patients with type 2 diabetes and
  elevated albuminuria
• In normoalbuminuric renal insufficiency, these
  changes were seen less frequently, likely
  reflecting greater contributions from aging,
  hypertension, and arteriosclerosis

Ekinci E. I. et al. Diabetes Care
2013363620-3626
11
Ekinci E. I. et al. Diabetes Care
2013363620-3626