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Although glomerular structure has been studied, careful evaluation of tubular basement membrane (TBM) structure in diabetes in humans has not been done. We measured proximal TBM width, glomerular basement membrane (GBM) width, mesangial fractional volume [Vv(Mes/glom)], mesangial matrix fractional volume [Vv(MM/glom)], and cortical interstitial fractional volume [Vv(Int/cortex)] in 35 insulin-dependent diabetic (IDDM) patients and 20 controls. The patients' mean age was 28 +/- 10 years (X +/- SD) and IDDM duration was 17 +/- 8 years. Twenty-five patients were normoalbuminuric, four microalbuminuric, and six had overt proteinuria. Tubular basement membrane and GBM widths were measured by the orthogonal intercept method and mesangial and interstitial parameters by point counting. The TBM width was 915 +/- 320 nm in IDDM patients and 558 +/- 116 nm in controls (P = 0.0005); the TBM width was also increased in normoalbuminuric patients (849 +/- 297 nm, P = 0.0005). The TBM width was strongly directly related to GBM width (r = 0.67, P < 0.001), Vv(Mes/glom) (r = 0.52, P < 0.01), and Vv(MM/glom) (r = 0.61, P < 0.001), but only weakly to Vv(Int/cortex) (r = 0.29, NS). The TBM width (r = 0.65, P < 0.001) and GBM width (r = 0.65, P < 0.001) were strongly related to hemoglobin A1C (HbA1C), while the Vv(Mes/glom) (r = 0.35, P < 0.05) and Vv(Int/cortex) (r = 0.30, NS) were only weakly related to HbA1C. Thus, increased proximal TBM width is an integral component of early nephropathology in IDDM patients. This study suggests that the metabolic disturbances of diabetes are strong determinants of the constellation of structural abnormalities occurring in human diabetic nephropathy.
P L Brito, and
P Fioretto, and
K Drummond, and
Y Kim, and
M W Steffes, and
J M Basgen, and
S Sisson-Ross, and
M Mauer
February 1988,
Diabetes research and clinical practice,
P L Brito, and
P Fioretto, and
K Drummond, and
Y Kim, and
M W Steffes, and
J M Basgen, and
S Sisson-Ross, and
M Mauer
January 2001,
Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia,
P L Brito, and
P Fioretto, and
K Drummond, and
Y Kim, and
M W Steffes, and
J M Basgen, and
S Sisson-Ross, and
M Mauer
January 1996,
International urology and nephrology,
P L Brito, and
P Fioretto, and
K Drummond, and
Y Kim, and
M W Steffes, and
J M Basgen, and
S Sisson-Ross, and
M Mauer
August 1984,
Diabetologia,
P L Brito, and
P Fioretto, and
K Drummond, and
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M W Steffes, and
J M Basgen, and
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M Mauer
January 1992,
Journal of diabetes and its complications,
P L Brito, and
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M Mauer
January 1993,
Kidney international,
P L Brito, and
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M W Steffes, and
J M Basgen, and
S Sisson-Ross, and
M Mauer
July 1986,
The Journal of clinical investigation,
P L Brito, and
P Fioretto, and
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M W Steffes, and
J M Basgen, and
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M Mauer
January 1970,
Advances in metabolic disorders,
P L Brito, and
P Fioretto, and
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M W Steffes, and
J M Basgen, and
S Sisson-Ross, and
M Mauer
April 1981,
Diabetes,
P L Brito, and
P Fioretto, and
K Drummond, and
Y Kim, and
M W Steffes, and
J M Basgen, and
S Sisson-Ross, and
M Mauer
January 1997,
The Turkish journal of pediatrics,
