Observational studyClinical journal of the American Society of Nephrology : CJASN2016
Structural Predictors of Loss of Renal Function in American Indians with Type 2 Diabetes.
Observational study in Clinical journal of the American Society of Nephrology : CJASN, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers.
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Who cites it
48 citing papers in PubMed, 89 citations in OpenAlex.
- Changes in Albuminuria But Not GFR are Associated with Early Changes in Kidney Structure in Type 2 Diabetes.Journal of the American Society of Nephrology : JASN · 2019Trial
- Trial
- Long-term Effect of Losartan on Kidney Disease in American Indians With Type 2 Diabetes: A Follow-up Analysis of a Randomized Clinical Trial.Diabetes care · 2016Trial
- The renal histopathology of nonproteinuric kidney impairment: a three center experience.Clinical and experimental medicine · 2024Article
- Artificial intelligence assists identification and pathologic classification of glomerular lesions in patients with diabetic nephropathy.Journal of translational medicine · 2024Article
- Morphometric analysis of chronicity on kidney biopsy: a useful prognostic exercise.Clinical kidney journal · 2024Review
- Article
- Article
- Loss of Glomerular Permselectivity in Type 2 Diabetes Associates With Progression to Kidney Failure.Diabetes · 2023Article
- The unique structural and functional characteristics of glomerular endothelial cell fenestrations and their potential as a therapeutic target in kidney disease.American journal of physiology. Renal physiology · 2023Review
- Comparative evaluation of glomerular morphometric techniques reveals differential technical artifacts between focal segmental glomerulosclerosis and normal glomeruli.Physiological reports · 2023Article
- DNA methylation markers for kidney function and progression of diabetic kidney disease.Nature communications · 2023Article
- Diagnostic criteria and etiopathogenesis of type 2 diabetes and its complications: Lessons from the Pima Indians.Presse medicale (Paris, France : 1983) · 2023Review
- SGLT2 inhibitors mitigate kidney tubular metabolic and mTORC1 perturbations in youth-onset type 2 diabetes.The Journal of clinical investigation · 2023Article
- Changes in CT-Based Morphological Features of the Kidney with Declining Glomerular Filtration Rate in Chronic Kidney Disease.Diagnostics (Basel, Switzerland) · 2023Article
- Addition of glomerular lesion severity improves the value of anemia status for the prediction of renal outcomes in Chinese patients with type 2 diabetes.Renal failure · 2022Observational
- Molecular programs associated with glomerular hyperfiltration in early diabetic kidney disease.Kidney international · 2022Article
- Youth versus adult-onset type 2 diabetic kidney disease: Insights into currently known structural differences and the potential underlying mechanisms.Clinical science (London, England : 1979) · 2022Article
- Serum Level of Polyubiquitinated PTEN and Loss of Kidney Function in American Indians With Type 2 Diabetes.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2022Observational
- miRNA-93-5p in exosomes derived from M2 macrophages improves lipopolysaccharide-induced podocyte apoptosis by targeting Toll-like receptor 4.Bioengineered · 2022Article
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Authors and funding
8 authors at 6 institutions in 1 country.
Funding
Abstract
BACKGROUND AND
objectivesDiabetes is the leading cause of kidney failure in the United States, but early structural determinants of renal function loss in type 2 diabetes are poorly defined. We examined the association between morphometrically determined renal structural variables and loss of renal function in 111 American Indians with type 2 diabetes who volunteered for a research kidney biopsy at the end of a 6-year clinical trial designed to test the renoprotective efficacy of losartan versus placebo. Participants were subsequently followed in an observational study, in which annual measurements of GFR (iothalamate) initiated during the clinical trial were continued. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Renal function loss was defined as ≥40% loss of GFR from the research examination performed at the time of kidney biopsy. Associations with renal function loss were evaluated by Cox proportional hazards regression. Hazard ratios (HRs) were reported per 1-SD increment for each morphometric variable.
resultsOf 111 participants (82% women; baseline mean [±SD] age, 46 years old [±10]; diabetes duration, 16 years [±6]; hemoglobin A1c =9.4% [±2.2]; GFR=147 ml/min [±56]; median albumin-to-creatinine ratio, 41 mg/g [interquartile range, 13-158]), 51 (46%) developed renal function loss during a median follow-up of 6.6 years (interquartile range, 3.1-9.0). Fourteen had baseline GFR <90 ml/min, and three had baseline GFR <60 ml/min. Higher mesangial fractional volume (HR, 2.27; 95% confidence interval [95% CI], 1.58 to 3.26), percentage of global glomerular sclerosis (HR, 1.63; 95% CI, 1.21 to 2.21), nonpodocyte cell number per glomerulus (HR, 1.50; 95% CI, 1.10 to 2.05), glomerular basement membrane width (HR, 1.48; 95% CI, 1.05 to 2.08), mean glomerular volume (HR, 1.42; 95% CI, 1.02 to 1.96), and podocyte foot process width (HR, 1.28; 95% CI, 1.03 to 1.60); lower glomerular filtration surface density (HR, 0.62; 95% CI, 0.41 to 0.94); and fewer endothelial fenestrations (HR, 0.68; 95% CI, 0.48 to 0.95) were each associated with GFR decline after adjustment for baseline age, sex, duration of diabetes, hemoglobin A1c, GFR, and treatment assignment during the clinical trial.
conclusionsQuantitative measures of glomerular structure predict loss of renal function in type 2 diabetes.
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