ARE GLOMERULAR-LESIONS ALTERNATIVES TO MICROALBUMINURIA IN PREDICTINGLATER PROGRESSION OF DIABETIC NEPHROPATHY

We inquired whether the type of diabetic glomerulosclerosis, diffuse o r nodular, is of value as an alternative to microalbuminuria in predic ting later progression of renal disease. To answer this question, we c onducted a retrospective cohort study in eleven Japanese non-insulin-d ependent diabetes mellitus patients with normo- to microalbuminuria. N odular diabetic glomerulosclerosis was found in six patients, and diff use diabetic glomerulosclerosis in five patients. The mean follow-up p eriod was 41.5 months (range 12-65). Three patients developed persiste nt proteinuria and one developed chronic renal failure. Mean level of serum creatinine in all patients was elevated from 0.97 +/- 0.23 mg/dl (SD) to 1.10 +/- 0.37 mg/dl (P = 0.098). The rate of increase in seru m creatinine was 0.068 +/- 0.115 mg/dl/year in nodular diabetic glomer ulosclerosis, and 0.023 +/- 0.069 mg/dl/year in a diffuse one. No diff erence was found between these two types of diabetic glomerulosclerosi s (P = 0.445). We conclude that in normo- to microalbuminuric diabetic nephropathy the type of diabetic glomerulosclerosis, diffuse or nodul ar, is not necessarily an alternative to microalbuminuria in predictin g its later progression in Japanese non-insulin-dependent diabetes mel litus patients.