1
|
方 晨, 孙 丽, 刘 研, 肖 力, 孙 林. [Non-Classical Clinical Types and Pathological Changes of Diabetic Kidney Disease: A Review]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1074-1079. [PMID: 38162079 PMCID: PMC10752793 DOI: 10.12182/20231160102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Indexed: 01/03/2024]
Abstract
Diabetic kidney disease (DKD) is a common complication of diabetes mellitus and approximately 1/3 of diabetic patients may progress to DKD. A typical early clinical manifestation of DKD is microalbuminuria and patients may present with macroproteinuria accompanied by a decrease in renal function condition as the disease progresses. It is generally believed that the likelihood of a reversal of the disease is reduced after the development of macroproteinuria in patients with DKD, and that eventually some patients' condition may develop into end-stage renal disease (ESRD). Moreover, the thickening of the glomerular basement membrane, mesangial matrix expansion, Kimmelstiel-Wilson (K-W) nodules, and glomerulosclerosis in end-stage diabetes mellitus are typical pathologic changes of DKD. However, some DKD patients, especially those with type 2 diabetes mellitus (T2DM) combined with DKD, may have diverse clinical manifestations, showing variations in disease progression and regression, and manifesting as non-classical types of DKD, such as normoalbuminuric DKD, proteinuria-reduced DKD, and DKD with rapid decline in renal function. In addition, the formation of crescents, a special pathological change, is observed in renal biopsy. However, this issue is currently under-recognized by clinicians and therefore deserves more attention. In order to improve clinicians' understanding of the presentations and pathological changes of non-classical DKD and the level of DKD prevention and treatment in China, we present a preliminary introduction to the clinical phenotypes and pathological changes of non-classical types of DKD in this paper by summarizing the findings of our prior studies as well as domestic and international literature.
Collapse
Affiliation(s)
- 晨茜 方
- 中南大学湘雅二医院 肾内科 (长沙 410011)Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - 丽雅 孙
- 中南大学湘雅二医院 肾内科 (长沙 410011)Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - 研 刘
- 中南大学湘雅二医院 肾内科 (长沙 410011)Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - 力 肖
- 中南大学湘雅二医院 肾内科 (长沙 410011)Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - 林 孙
- 中南大学湘雅二医院 肾内科 (长沙 410011)Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| |
Collapse
|
2
|
Lee CH, Lui DTW, Cheung CYY, Fong CHY, Yuen MMA, Chow WS, Xu A, Lam KSL. Circulating thrombospondin-2 level for identifying individuals with rapidly declining kidney function trajectory in type 2 diabetes: a prospective study of the Hong Kong West Diabetes Registry. Nephrol Dial Transplant 2023:gfad034. [PMID: 36857285 DOI: 10.1093/ndt/gfad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Thrombospondin-2 (TSP2) is a matricellular protein with tissue expression induced by hyperglycaemia. TSP2 has been implicated in non-diabetic renal injury in preclinical studies and high circulating levels were associated with worse kidney function in cross-sectional clinical studies. Therefore, we investigated the prospective associations of circulating TSP2 level with kidney function decline and the trajectories of estimated glomerular filtration rate (eGFR) in type 2 diabetes. METHODS Baseline serum TSP2 level was measured in 5471 patients with type 2 diabetes to evaluate its association with incident eGFR decline, defined as ≥ 40% sustained eGFR decline, using multivariable Cox regression analysis. Among participants with relatively preserved kidney function (Baseline eGFR ≥ 60 ml/min/1.73m2), joint latent class modelling was employed to identify three different eGFR trajectories. Their associations with baseline serum TSP2 was evaluated using multinomial logistic regression analysis. The predictive performance of serum TSP2 level was examined using time-dependent c-statistics and calibration statistics. RESULTS Over a median follow-up of 8.8 years, 1083 patients (19.8%) developed eGFR decline. Baseline serum TSP2 level was independently associated with incident eGFR decline (HR 1.21, 95%CI 1.07-1.37, P = 0.002). With internal validation, incorporating serum TSP2 to a model of clinical risk factors including albuminuria led to significant improvement in c-statistics from 83.9 to 84.4 (P < 0.001). Among patients with eGFR ≥ 60 ml/min/1.73m2, baseline serum TSP2 level was independently associated with a rapidly declining eGFR trajectory (HR 1.63, 95%CI 1.26-2.10, P < 0.001). CONCLUSION Serum TSP2 level was independently associated with incident eGFR decline, particularly a rapidly declining trajectory, in type 2 diabetes.
Collapse
Affiliation(s)
- Chi-Ho Lee
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong
| | - David Tak-Wai Lui
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Chloe Yu-Yan Cheung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Carol Ho-Yi Fong
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | | | - Wing-Sun Chow
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Aimin Xu
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong
| | - Karen Siu-Ling Lam
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong
| |
Collapse
|
3
|
Herder C, Roden M. A novel diabetes typology: towards precision diabetology from pathogenesis to treatment. Diabetologia 2022; 65:1770-1781. [PMID: 34981134 PMCID: PMC9522691 DOI: 10.1007/s00125-021-05625-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/04/2021] [Indexed: 02/07/2023]
Abstract
The current classification of diabetes, based on hyperglycaemia, islet-directed antibodies and some insufficiently defined clinical features, does not reflect differences in aetiological mechanisms and in the clinical course of people with diabetes. This review discusses evidence from recent studies addressing the complexity of diabetes by proposing novel subgroups (subtypes) of diabetes. The most widely replicated and validated approach identified, in addition to severe autoimmune diabetes, four subgroups designated severe insulin-deficient diabetes, severe insulin-resistant diabetes, mild obesity-related diabetes and mild age-related diabetes subgroups. These subgroups display distinct patterns of clinical features, disease progression and onset of comorbidities and complications, with severe insulin-resistant diabetes showing the highest risk for cardiovascular, kidney and fatty liver diseases. While it has been suggested that people in these subgroups would benefit from stratified treatments, RCTs are required to assess the clinical utility of any reclassification effort. Several methodological and practical issues also need further study: the statistical approach used to define subgroups and derive recommendations for diabetes care; the stability of subgroups over time; the optimal dataset (e.g. phenotypic vs genotypic) for reclassification; the transethnic generalisability of findings; and the applicability in clinical routine care. Despite these open questions, the concept of a new classification of diabetes has already allowed researchers to gain more insight into the colourful picture of diabetes and has stimulated progress in this field so that precision diabetology may become reality in the future.
Collapse
Affiliation(s)
- Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany.
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany.
| |
Collapse
|
4
|
Bonora E, Trombetta M, Dauriz M, Brangani C, Cacciatori V, Negri C, Pichiri I, Stoico V, Rinaldi E, Da Prato G, Boselli ML, Santi L, Moschetta F, Zardini M, Bonadonna RC. Insulin resistance and beta-cell dysfunction in newly diagnosed type 2 diabetes: Expression, aggregation and predominance. Verona Newly Diagnosed Type 2 Diabetes Study 10. Diabetes Metab Res Rev 2022; 38:e3558. [PMID: 35717608 PMCID: PMC9786655 DOI: 10.1002/dmrr.3558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 12/30/2022]
Abstract
AIMS We investigated quantitative expression, mutual aggregation and relation with hyperglycemia of insulin resistance (IR) and beta-cell dysfunction (BCD) in newly diagnosed type 2 diabetes. METHODS We assessed IR with euglycemic hyperinsulinemic clamp and BCD with modelled glucose/C-peptide response to oral glucose in 729 mostly drug-naïve patients. We measured glycated hemoglobin, pre-prandial, post-prandial and meal-related excursion of blood glucose. RESULTS IR was found in 87.8% [95% confidence intervals 85.4-90.2] and BCD in 90.0% [87.8-92.2] of subjects, ranging from mild to moderate or severe. Approximately 20% of subjects had solely one defect: BCD 10.8% [8.6-13.1] or IR 8.6% [6.6-10.7]. Insulin resistance and BCD aggregated in most subjects (79.1% [76.2-82.1]). We arbitrarily set nine possible combinations of mild, moderate or severe IR and mild, moderate or severe BCD, finding that each had a similar frequency (∼10%). In multiple regression analyses parameters of glucose control were related more strongly with BCD than with IR. CONCLUSIONS In newly-diagnosed type 2 diabetes, IR and BCD are very common with a wide range of expression but no specific pattern of aggregation. Beta-cell dysfunction is likely to play a greater quantitative role than IR in causing/sustaining hyperglycemia in newly-diagnosed type 2 diabetes.
Collapse
Affiliation(s)
- Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Maddalena Trombetta
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Corinna Brangani
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Vittorio Cacciatori
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Carlo Negri
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Isabella Pichiri
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Vincenzo Stoico
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Elisabetta Rinaldi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Giuliana Da Prato
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Maria Linda Boselli
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Lorenza Santi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Federica Moschetta
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Monica Zardini
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of MedicineUniversity and Hospital Trust of VeronaVeronaItaly
| | - Riccardo C. Bonadonna
- Department of Medicine and SurgeryUniversity of Parma, and Division of Endocrinology and Metabolic DiseasesAzienda Ospedaliero‐Universitaria di ParmaParmaItaly
| |
Collapse
|