5). Case 5. IgA nephropathy A 50-year-old man presented with significant proteinuria, 5 years post diagnosis of T2DM. His medical history included obesity, hypertension and hyperlipidaemia. Urinary protein excretion was 11 g/day, with normal eGFR and active urinary sediment. HbA1C was
8%. Renal biopsy showed features of mesangial proliferative IgA nephropathy www.selleckchem.com/products/acalabrutinib.html with chronic tubulointerstitial damage and nephrosclerosis (Fig. 6). Case 6. Membranous nephropathy and anti-GBM disease7 A 22-year-old male with T1DM presented with nephrotic syndrome (urinary protein excretion 14 g/day, serum albumin 23 g/L), acute kidney injury (serum creatinine 387 μmol/L) and active urinary sediment (>1000 × 106/L dysmorphic erythrocytes). Renal biopsy showed focal segmental necrotizing glomerulonephritis on a background of moderate nodular mesangial expansion and hypercellularity with several showing Kimmelstiel–Wilson nodules (Fig. 7). Immunofluorescence showed strong linear GBM staining for IgG. Electron microscopy showed Stage 1 membranous nephropathy with small subepithelial electron dense ‘immune-type’ deposits with GBM membrane spike formation. The earliest clinical evidence of classical DKD is the appearance of microalbuminuria
GDC973 (≥ 30 mg/day or 20 μg/min). Without specific interventions, up to 80% of T1DM patients with sustained microalbuminuria develop overt proteinuria (≥300 mg/day or ≥200 μg/min) over 10–15 years.[8-10] ESRD develops in 50% of T1DM patients with overt proteinuria within 10 years and in >75% by 20 years. A higher proportion of T2DM individuals are found to have established proteinuria at the time of diagnosis of their diabetes due to the delay in the diagnosis of diabetes. Without specific interventions, up to 40% of T2DM patients Amino acid with
microalbuminuria progress to overt nephropathy, but by 20 years after onset of overt nephropathy, only approximately 20% will progress to ESRD. The exact reasons why an individual with diabetes will progress to develop DKD and then subsequently develop ESRD still remain to be fully defined. Despite this, there is most likely a strong genetic determinant for the risk of developing DKD and ESRD. Indeed, recent genomic-wide linkage studies have described the localization of quantitative trait loci that influence GFR in diabetes.[12, 13] These findings may help to further elucidate the genetic susceptibility to the development of advanced DKD. The spectrum of histologic changes seen in DKD is variable. In 2010, a new pathological classification of DKD was proposed for patients with diabetes, based on glomerular features: Class I: Glomerular basement membrane (GBM) thickening, diagnosed by transmission electron microscopy. Class II: Mesangial expansion – A: mild; B: severe. Class III: Nodular glomerulosclerosis (Kimmelstiel–Wilson lesion). Class IV: Advanced diabetic glomerulosclerosis (>50% global glomerulosclerosis).