The relative prognosis of nodular and diffuse diabetic nephropathy

Material and methods: One hundred and forty-four diabetic patients with bio psy-proven diffuse diabetic glomerulosclerosis (DIF), 134 patients with nod ular diabetic nephropathy (NOD) and 152 diabetic patients with nondiabetic- related morphology (104 chronic nephropathy. 48 primary GN) were followed f or up to 12 years to determine the clinical prognosis. Results: Comparing the NOD patients with the DIF patients, there were more females (41% vs 26%, p < 0.05) and they were more often uremic at biopsy (2 4% vs 12%, p < 0.01), but the age was similar (53.3 years vs 50.1 years, NS ). There was no difference in diabetes type I and II incidence. Compared wi th the general population, the odds ratio (OR) for death was 7.2 (confidenc e interval 5.5-9.5) for DIF and 10.8 (8.5-13.7) for NOD. The OR for combine d renal or patient death was: DIF 15.2 (11.7-19,7); NOD 24.6 (19.3-31.0). A fter correction for age, sex, and pre-existing uremia, NOD had a 1.70 (p < 0.01) times increased risk of death compared with DIF, and a 2.42 (p < 0.01 ) times increased risk of renal failure. The life expectancy for NOD was 4. 0 years, and average time to dialysis was 2.1 years. NOD prognosis was simi lar to other chronic nephropathy. The incidence of all atherosclerotic comp lications except AMI was twice as high in NOD than DIF. Diabetes type had n o influence on prognosis. The estimated incidence of diabetic nephropathy w as 56/mio/year. Conclusion: Nodular diabetic nephropathy has a poorer prognosis than diffus e due to a higher rate of atherosclerotic and uremic complications.