Diabetic Glomerulosclerosis Severity Tied to Outcomes in Glomerular Disease – Renal and Urology News

The presence and severity of diabetic glomerulosclerosis appear to be important factors in the prognosis of patients with primary glomerular disease, according to investigators.

Amy K. Mottl, MD, MPH, of the University of North Carolina Kidney Center at Chapel Hill, and colleagues explored progression to end-stage kidney disease (ESKD) or death in the presence of type 1 or 2 diabetes among 134 patients with a biopsy-confirmed primary glomerular disease. These included focal segmental glomerulosclerosis, IgA nephropathy, minimal change disease, membranous nephropathy, or antineutrophil cytoplasmic autoantibody glomerulonephritis.

The composite endpoint of ESKD or death occurred at a higher rate among patients with diabetic glomerulosclerosis vs glomerular disease alone: 22.5 vs 10.2 cases per 100 person-years. Patients with moderate to severe diabetic glomerulosclerosis (class 2b, 3, 4) had a significant 4-fold higher risk for the composite outcome than patients with glomerular disease alone, the investigators reported in Kidney360. Mild diabetic glomerular pathology (class 1, 2a), however, did not carry a greater risk of progression or death.

“Among those with diabetes glomerular class 2b or worse, 40% suffered ESKD or death in 1 year and 60% in 2 years,” Dr Mottl’s team reported. “Such prognostic implications are important to discuss with patients, particularly during shared decision-making regarding immunosuppression.”

Patients with diabetic glomerulosclerosis had greater frequency of insulin therapy and higher baseline proteinuria than those with glomerular disease alone.

Diabetes duration and glycemic control and immunosuppression did not differ between those with mild vs moderate to severe diabetic glomerulosclerosis. In a future study, the team will be investigating whether use of immunosuppression, particularly glucocorticoids, is less effective in inducing remission in patients with concomitant moderate to severe diabetic lesions.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.