The Correlation Between Renal Interstitial Vascular Lesion And Renal Prognosis In Patients With Type 2 Diabetic Nephropathy

Objective:To investigate the renal interstitial vascular lesion in patients with type 2diabetic nephropathy(T2DN)and it's effect on prognosis.Methodology:89 T2 DM patients who had renal biopsy-confirmed T2 DN from January2008 to March 2019 at General hospital of NingXia medical university were enrolled in this retrospective study,Collecting general data?laboratory indicators and pathological data for patients with follow-up at least 6 months.All cases were categorized according to the pathologic classification of Tervaert haved reported.Renal event was defined as doubling of baseline serum creatinine?renal replacement therapy and death,Kaplan-meier survival curve,univariate and multivariate Cox regression were used to analyze renal interstitial vascular lesion on prognosis of T2 DN patients.Results:1?They were 26 male and 63 female with an average age of 45.66±8.56 years old.The median follow-up was 28(6-102)months.,Among them,there were 5(5.6%)in class I,16(18%)class IIa,11(12.36%)class IIb,55(61.8%)class ?,2(2.24%)class ?,The highest proportion in glomerular lesions was ?.Glomerular classes was positively correlated with IFTA(r=0.271 p=0.010)?arteriolar hyalinosis(r=0.277 p=0.009),not correlated with interstitial inflammation(r=0.000 p=0.999)and vascular arteriosclerosis(r=0.022 p=0.837).2?With the aggravation of IFTA,The estimated glomerular filtration rate(eGFR)(p<0.001)and hemoglobin(Hb)(p=0.016)decreased gradually,the Serum Uric Acid(SUA)(p=0.009)?Quantitative Test of 24 h Urinary Protein(UP)(p=0.002)and Diabetic retinopathy(DR)(p=0.006)increased gradually.IFTA was positively correlated with SUA(r=0.308p=0.003)? UP(r=0.359 p=0.001)and DR(r=0.355 p=0.001),negatively correlation witheGFR(r=-0.682 p<0.001)and Hb(r=-0.313 p=0.003).3?With the aggravation of interstitial inflammation,The eGFR(p=0.003)decreased and SUA(p=0.011)increased gradually.Interstitial inflammation was positively correlated with SUA(r=0.227 p=0.032)?UP(r=0.237p=0.026),negatively correlation with eGFR(r=-0.239 p=0.024).4 ? With the increase of arteriolar hyalinosis score,the age(p=0.028)? DR(p=0.006)and UP(p=0.031)increased gradually,and the eGFR(p=0.005)decreased gradually.Arteriolar hyalinosis was positively correlated with age(r=0.262 p=0.013)?DR(r=0.338 p=0.001)and UP(r=0.257 p= 0.016)negatively correlation with eGFR(r=-0.327 p=0.002).5 ? Prognostic analysis:The mean follow-up duration was 28(6-102)months.52 patients reached the renal outcome.Kaplan-Meier showed that the higher the IFTA score,the worse the kidney survival.For arteriolar hyalinosis,patients in group 0 had the best renal survival,in group 2 had the worst renal survival,There was no significant difference in renal prognosis between the interstitial inflammation score group and arteriolar hyalinosis score group.Univariate COX regression analysis showed that Glomerular classes(p<0.001)?IFTA(p<0.001)and arteriolar hyalinosis lesion(p<0.001)were the risk factors for renal prognosis.Multivariate COX analysis showed that the glomerular class was independent risk factors for prognosis.Conclusion:1?IFTA,interstitial inflammation and arteriolar hyalinosis were common in DN.IFTA accounted for 93.26%,Interstitial inflammatory and arteriolar hyalinosis accounted for 92.13% respectively.2?Glomerular classes was positively correlated with IFTA score group and arteriolar hyalinosis score group?3?The higher the IFTA score,the worse the anemia?renal function,the higher SUA?DR and UP.4?Glomerular classes was an independent risk factor for prognosis.