GLOMERULAR ULTRASTRUCTURE IN KIDNEYS TRANSPLANTED SIMULTANEOUSLY WITHA SEGMENTAL PANCREAS TO PATIENTS WITH TYPE-1 DIABETES

Background. Pancreas transplantation has been reported to prevent deve lopment and progression of diabetic glomerulopathy. Study design. Kidn eys transplanted to type 1 diabetic patients were investigated for sig ns of diabetic glomerulopathy. Biopsies were obtained from 11 patients 2-4 years after simultaneous pancreas and kidney transplantation and from six patients 2-6 years after kidney transplantation alone. During follow-up, glycaemic control was monitored as glycated haemoglobin an d, in the pancreas transplant patients, as i.v. glucose tolerance. Res ults. Measures of glycaemic control were consistently normal in only t wo pancreas transplant patients. Four had mean k values <1.0. In kidne y biopsies from the pancreas transplant patients, thickness of the glo merular basement membrane was 395 (0.13) nm (mean, coefficient of vari ation), which is higher than normal (324 (0.13) mn, P=0.01) and not di fferent from diabetic patients with kidney transplants alone, 418 (0.1 5)nm. The mean calculated annual increase in thickness did not differ between patients with and without a pancreas transplant, 26 (0.77) ver sus 29 (0.54) nm/year. Estimates of the mesangium and mesangial matrix were in the normal range in both groups while the interstitial volume fraction was increased and to a similar extent. Conclusion. The incre ase in thickness of the glomerular basement membrane in kidneys transp lanted simultaneously with a segmental pancreas is probably an express ion of diabetic glomerulopathy caused by the modest impairment in gluc ose metabolism present in most patients.