Clinical reflections of diabetic nephropathy related pathological lesions

Background The Renal Pathology Society developed a universal pathological classification of diabetic nephropathy in 2010. Some research has been conducted to validate this classification’s ability to predict the outcome. However, the clinical implications of these pathological abnormalities are still being investigated. Objectives In this study, we aimed to demonstrate the clinical reflections of these lesions to better understand the underlying mechanisms. Methods Data of 119 patients with biopsy proven diabetic nephropathy from a single center were included in the study. Pathology specimens were reclassified according to 2010 criteria suggested by the RPS. Results Diabetic retinopathy was more frequently present in patients with advanced glomerular class, IFTA score, interstitial inflammation score, arteriolar hyalinosis score, arteriosclerosis score, and in patients with exudative lesions present ( p < 0.05). The proteinuria levels of patients with advanced glomerular classes and exudative lesions were significantly higher, and serum albumin levels were lower ( p < 0.05). Hematuria occurrence was more frequent in glomerular class III and IV patients and in patients with advanced arteriolar hyalinosis ( p < 0.05). Conclusion This large, single center, retrospective study reveals that diabetic retinopathy is associated with glomerular and arteriolar lesions but not with interstitial lesions. Proteinuria and hematuria were independent predictors of glomerular lesions, but not other renal lesions. Nevertheless, prospective studies which include all the confounding clinical factors are required to reach a conclusion on the relationship of hematuria and renal lesions.