Association of podocyte ultrastructural changes with proteinuria and pathological classification in type 2 diabetic nephropathy

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism Pub Date : 2024-06-07 DOI:10.1016/j.diabet.2024.101547

Yue Zhou , Shuang Hou , Xiao-yan Huang , Dong-yuan Chang , Hui Wang , Lin Nie , Zu-ying Xiong , Min Chen , Ming-hui Zhao , Su-xia Wang

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Abstract

Aims

Podocyte injury plays an essential role in the progression of diabetic nephropathy (DN). The associations between the ultrastructural changes of podocyte with proteinuria and the pathological classification of DN proposed by Renal Pathology Society (RPS) have not been clarified in patients with type 2 diabetic nephropathy (T2DN).

Methods

We collected 110 patients with kidney biopsy-confirmed T2DN at Peking University First Hospital from 2017 to 2022. The morphometric analysis on the podocyte foot process width (FPW) and podocyte detachment (PD) as markers of podocyte injury was performed, and the correlations between the ultrastructural changes of podocytes with severity of proteinuria and the RPS pathological classification of DN were analyzed.

Results

Mean FPW was significantly broader in the group of T2DN patients with nephrotic proteinuria (565.1 nm) than those with microalbuminuria (437.4 nm) or overt proteinuria (494.6 nm). The cut-off value of FPW (> 506 nm) could differentiate nephrotic proteinuria from non-nephrotic proteinuria with a sensitivity of 75.3% and a specificity of 75.8%. Percentage of PD was significantly higher in group of nephrotic proteinuria (3.2%) than that in microalbuminuria (0%) or overt proteinuria (0.2%). FPW and PD significantly correlated with proteinuria in T2DN (r = 0.473, p < 0.001 and r = 0.656, P < 0.001). FPW and PD correlated with RPS pathological classification of T2DN (r = 0.179, P = 0.014 and r = 0.250, P = 0.001). FPW value was increased significantly with more severe DN classification (P for trend =0.007). The percentage of PD tended to increase with more severe DN classification (P for trend = 0.017).

Conclusions

Podocyte injury, characterized by FPW broadening and PD, was associated with the severity of proteinuria and the pathological classification of DN.

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2 型糖尿病肾病患者荚膜细胞超微结构变化与蛋白尿和病理分类的关系

目的：荚膜损伤在糖尿病肾病（DN）的进展过程中起着至关重要的作用。在2型糖尿病肾病（T2DN）患者中，荚膜细胞超微结构变化与蛋白尿以及肾脏病理学会（RPS）提出的DN病理分类之间的关联尚未明确：我们收集了北京大学第一医院2017年至2022年110例经肾活检证实的T2DN患者。以荚膜脚突宽（FPW）和荚膜脱落（PD）作为荚膜损伤的标志物进行形态学分析，并分析荚膜细胞超微结构变化与蛋白尿严重程度及DN的RPS病理分级之间的相关性：结果：与微量白蛋白尿（437.4 nm）或明显蛋白尿（494.6 nm）患者相比，肾病性蛋白尿 T2DN 患者组的平均 FPW（565.1 nm）明显更宽。FPW 临界值（> 506 nm）可区分肾病性蛋白尿和非肾病性蛋白尿，灵敏度为 75.3%，特异度为 75.8%。肾病性蛋白尿组的 PD 百分比（3.2%）明显高于微量白蛋白尿组（0%）或明显蛋白尿组（0.2%）。在 T2DN 中，FPW 和 PD 与蛋白尿明显相关（r = 0.473，P < 0.001 和 r = 0.656，P < 0.001）。FPW 和 PD 与 T2DN 的 RPS 病理分类相关（r = 0.179，P = 0.014 和 r = 0.250，P = 0.001）。FPW值随着更严重的DN分类而明显增加（趋势P=0.007）。结论：结论：以 FPW 变宽和 PD 为特征的荚膜损伤与蛋白尿的严重程度和 DN 的病理分类有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes & metabolism 医学-内分泌学与代谢

CiteScore

12.00

自引率

4.20%

发文量

审稿时长

13 days

期刊介绍： A high quality scientific journal with an international readership Official publication of the SFD, Diabetes & Metabolism, publishes high-quality papers by leading teams, forming a close link between hospital and research units. Diabetes & Metabolism is published in English language and is indexed in all major databases with its impact factor constantly progressing. Diabetes & Metabolism contains original articles, short reports and comprehensive reviews.

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