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May 17, 2013Journal of the American Society of Nephrology

Renal Lesions Predict Progression of Diabetic Nephropathy in Type 1 Diabetes

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Why the study?

Do early renal structural parameters predict the development of proteinuria or ESRD in normoalbuminuric patients with type 1 diabetes?

Population

94 normoalbuminuric patients with longstanding type 1 diabetes, age ≥18 years, not on RAS blocking agents at…

Design

Cohort

Follow-up

11.0 ± 7.2 years

Key result

Greater baseline glomerular basement membrane width and higher A1c levels independently predicted progression to proteinuria or ESRD, with no patients having normal GBM width developing these outcomes over 11 years.

Authors

MCMaria Luiza CaramoriAPAlicia ParksMMMichael Mauer

Discussion

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Overview

May aid risk stratification in normoalbuminuric type 1 diabetes; hypothesis-generating and requires prospective validation before clinical use.

Study Design

Type

Cohort (n=94)

Multicenter

No

Structured PICO

Do early renal structural parameters predict the development of proteinuria or ESRD in normoalbuminuric patients with type 1 diabetes?

P
Population
94 normoalbuminuric adults with type 1 diabetes for at least 5 years who underwent baseline kidney biopsies, followed for an average of 11 years to assess progression to clinical diabetic nephropathy.
O
Outcome
Composite end point of proteinuria and/or ESRDcomposite

Main Result

Absolute Event Rate: 33.3% vs 0%

p-value: p=0.008

Greater glomerular basement membrane width and higher A1c levels independently predict progression to diabetic nephropathy in normoalbuminuric patients with type 1 diabetes.

Limitations

  • 12 patients lost to follow-up could not be found in registries, possibly overestimating progression incidence.
  • Small cohort size limits analysis of complex relationships like age of onset and sex.
  • Practicality challenges of adopting invasive renal biopsies in routine patient care.
  • Small cohort size
  • Potential ascertainment bias due to 12 patients lost to follow-up
  • Invasive nature of renal biopsies limits routine clinical use

Cite This Study

Caramori et al. (2013) conducted a cohort in Type 1 Diabetes (n=94). Greater glomerular basement membrane (GBM) width vs. Normal GBM width was evaluated on Progression to a composite of proteinuria and/or ESRD (p=0.008). Greater baseline glomerular basement membrane width and higher A1c levels independently predicted progression to proteinuria or ESRD, with no patients having normal GBM width developing these outcomes over 11 years.

synapsesocial.com/papers/6a7baa3c11f9f91080ed211fhttps://doi.org/10.1681/asn.2012070739
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Low Glomerular Filtration Rate in Normoalbuminuric Type 1 Diabetic Patients2003 · 307 citations
  2. 2Predicting Diabetic Nephropathy in Insulin-Dependent Patients1984 · 1,587 citations
  3. 3Glomerular Structure and Function in Type 2 Diabetes Stratified by Glomerular Basement Membrane Thickening2026
  4. 4Follow‐up study of glomerular dimensions and cortical interstitium in microalbuminuric type 1 diabetic patients with or without antihypertensive treatment2000 · 26 citations
  5. 5Risk Factors for Development of Incipient and Overt Diabetic Nephropathy in Type 1 Diabetic Patients2002 · 246 citations