The Study And Analysis Of The Correlation Of Pathological Factors With Clinical Factors And Prognosis In Diabetic Nephropathy

BackgroudDN?diabetic nephropathy?is a common complication of diabetes mellitus,and is the second cause of ESRD?end stage renal disease?in China,resulting in a huge medical burden.The main pathological features of DG?diabetic glomerulopathy?are GBM?glomerular basement membrane?thickening,expansion of mesangial matrix,formation of K-W nodules?Kimmelstiel-Wilson nodules?K-W nodules and IFTA?interstitial fibrosis and tubular atrophy?.K-W nodules and global glomerular sclerosis are the two main factors to classify advance?class III and class IV?DG.Some studies have proved the correlation of pathological factors including K-W nodules,IFTA and global glomerular sclerosis with clinical manifestation and renal prognosis.However,there are no study on the correlation of quantity or proportion of K-W nodules?number of K-W nodules per glomerulus without sclerosis?.Objectives1.To study and analyze the effect of the quanily and the proportion of K-W nodules on the clinical factors and renal prognosis;2.To study and analyze of correlation between global sclerosis/IFTA and the clinical factors/renal prognosis;3.Verify and evaluate the new classification system of DN by Tervaert in 20106.MethodScreening the patients who were over 18 when hospitalized in Peking Union Medical College Hospital during Janlst,2009 to Dec 31st,2016,and diagnosed with diabetic nodular glomerulosclerosis?NOD?or diabetic diffuse glomerulosclerosis?DIF?,with complete clinical and pathological statistics,with a follow-up period over 6 months and complete follow-up statistics,without other primary/secondary acute/chronic kindey diseases.41 patients?3 were type 1 DM?were included in our study,in which 27 patients were diagnosed with NOD and 14 were diagnosed with DIF.We collected and analysed the statistics and overscan digital slides using NanoZoomer Digital Pathology system,by which we could get single pathological factors and analyze the effect of K-W nodules,proportions of global glomerular sclerosis and IFTA to clinical factors and prognosis.Results1.For patients included in the study,those who were diagnosed with NOD,had higher 24hUP?5.10±0.70g vs₉.21±0.98g,P=0.007?and lower Alb?38±1g/L vs 29±1g/L,P=0.000?,HGB?129±6g/L vs 106±4g/L,P=0.002?and BMI?27.34±0.96Kg/m2 VS 24.54±0.69Kg/m2,P=0.022?than those who were diagnosed with DIF.Proportion of K-W nodules was in positive correlation with SCr?correlation coefficient 0.436,P=0.004?,and in negative correlation with HGB?correlation coefficient-0.556,P=0.000?,and there was no correlation between proportion of K-W nodules and 24hUP/eGFR.2.During the median follow-up time of 21 months,23 patients came to the renal outcome event while 18 patients did not.There were no statistical differences between the two groups.Patients who came to the outcome event had higher baseline SCr?127 ± 10?mol/L vs 192 ± 30?mol/L,P=0.028?and higher rate of descent of eGFR?0.24 ± 0.35ml/min/1.73m2 vs 1.80 ± 0.57ml/min/1.73m2,P=0.019?and lower HGB?120 ± 4g/L vs 105 ± 6g/L,P=0.041?.Proportion of K-W nodules was in negative correlation with renal prognosis,and there no statistic difference of K-W nodules with 24hUP,Alb,HGB,eGFR,global glomerular sclerosis and IFTA.3.Proportion of global glomerular sclerosis was in positive correlation with Alb?correlation coefficient:0.67,P=0.000?,proportion of IFTA?IFTA%??correlation coefficient:0.63,P=0.000?and in negative correlation with eGFR?correlation coefficient:-0.38,P=0.015?.IFTA%was in positive correlation with Alb?correlation coefficient:0.35,P=0.025?and proportion of global glomerular sclerosis?correlation coefficient:0.436,P=0.004?.Patients whose proportion of IFTA was over 50%had higher Alb?30 ± lg/L vs 35±2 g/L,P=0.025?and higher proportion of global glomerular sclerosis?0.20 ±0.03 vs 0.39 ±0.06,P=0.004?,there is no statistic difference between IFTA%and renal prognosis.4.According to the pathological classification of diabetic nephropathy patients diagnosed with class IV has higher SCr?138.3 ± 10.7?mol/L vs 233.0 ± 56.3 ?mol/L,P=0.017?.Alb?28±1g/L vs 35±1g/L,P=0.000?.proportion of IFTA?0.44 ±0.04 vs 0.66 ±0.07,P=0.007?than patients diagnosed with class ?,and lower proportion of K-W nodules?0.25 ± 0.30 vs 0.18 ± 0.11,P=0.007?.But for renal prognosis,no statistic difference was seen between the two groups?P=0.783?.Conclusion1.Patients who are diagnosed with NOD are worse for 24hUP.Alb and HGB;The higher the proportion of K-W nodules is,the worse the renal prognosis is.2.Proportion of K-W nodules has no correlation with proportion of global glomerular sclerosis and proportion of IFTA;proportion of IFTA and proportion of global glomerular sclerosis have correlation with each other.3.Patients whose proportion of global sclerosis is higher have higher Alb,SCr and IFTA and lower eGFR;no correlation is found between IFTA and renal prognosis.4.According to the new DN pathological classification system by Tervaert in 2010,clinical and pathological factors of patients disagnosed with class IV are worse than patients of class III,and no statistic difference is found between the two classes,which may result by the small sample size.5.Digital slicing system can contribute a lot to the quantitative analysis of nephropathology,and may be a prospective tool for research in the future.