This finding appears to be in support of the newer pathogenetic theories of diabetic nephropathy that suggest that diabetic tubulopathy occurs earlier than
diabetic glomerulopathy [38].
Given that the extent of renal dysfunction correlates well with the degree of interstitial fibrosis [6], diabetic tubulopathy must be considered and explored as much as
diabetic glomerulopathy in the pathogenesis of DKD.
Wolf, "Pathogenesis of the podocytopathy and proteinuria in
diabetic glomerulopathy," Current Diabetes Reviews, vol.
Diabetic glomerulopathy is characterized by excessive accumulation of glomerular basement membrane and mesangial matrix.
Prevention of
diabetic glomerulopathy in streptozotocin diabetic rats by insulin treatment.
Pathogenesis of the podocytopathy and proteinuria in
diabetic glomerulopathy. Curr Diabetes Rev 2008; 4: 39-45.
Figure 2 shows a light microscopic examination of kidneys from diabetic animals revealing
diabetic glomerulopathy characterized by thickening of the glomerular basement membrane, mesangial matrix expansion, arteriolar hyalinosis, and large hyaline proteinaceous droplets (arrow) within the glomeruli (H&E, 200x), occluding capillary loops and attached outside the Bowman's capsule.
Capillaries are variably thickened as compared with the uniform thickening seen in
diabetic glomerulopathy. Glomerular basement membranes can also be focally or diffusely thickened because of the widespread infiltration of the subepithelial, intramembranous, and subendothelial, organized deposits.
Early detection of podocyte lesions in
diabetic glomerulopathy could give the clinician a chance to revert kidney disease by way of implementing appropriate therapeutic measures--a chance missed if one relied solely on the level of albuminuria.
The diagnosis of diabetic kidney disease (DKD) can usually be made with careful clinical and laboratory assessment, but kidney biopsy might be required to prove the presence of
diabetic glomerulopathy. Macroalbuminuria--or microalbuminuria in a patient with type 1 diabetes for more than 10 years or diabetic retinopathy--is highly suggestive of DKD.
The key changes in
diabetic glomerulopathy is thickening of the basement membrane, mesangial cell hypertrophy and accumulation of mesangial matrix (Kimmelstiel-Wilson nodules).
Structural and functional changes in
diabetic glomerulopathy. Kidney Blood Press Res.
