Evidence map›Paper›PMID 41061855›Full record

ArticleKidney international2026

Heterogeneity in the relationships between albuminuria and glomerular structure in type 1 and type 2 diabetes.

Behzad Najafian, Maria Luiza Caramori, Michele Dalla Vestra, Alois Saller, Mehrdad Noruzinia, Michael Mauer, Paola Fioretto

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Kidney international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Behzad NajafianDepartment of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA; Department of Medicine, University of Washington, Seattle, Washington, USA. Electronic address: najafian@uw.edu.
Maria Luiza CaramoriInstitute of Medical Specialties, Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio, USA; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Michele Dalla VestraDepartment of Internal Medicine, Ospedale dell'Angelo, Mestre, Italy.
Alois SallerDepartment of Internal Medicine, S. Antonio Hospital, Padua, Italy.
Mehrdad NoruziniaDepartment of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
Michael MauerDepartment of Medicine, University of Minnesota, Minneapolis, Minnesota, USA; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
Paola FiorettoDepartment of Medicine, University of Padova, Padova, Italy.

Funding

Viral Infections and Posttransplant MorbidityP01DK013083 · NIDDK · UNIVERSITY OF MINNESOTA TWIN CITIES · PI MATAS, ARTHUR J · 1986 to 2013
$14.9M
Urinary Biomarkers in Biopsy Defined Early Nephropathy in Types 1 and 2 DiabetesU01DK085651 · NIDDK · UNIVERSITY OF MINNESOTA · PI MAUER, S. MICHAEL · 2009 to 2013
$2.2M
NIDDK NIH HHS P01 DK013083NIDDK NIH HHS U01 DK085651
6 · The paper itself

Abstract

introductionKidney structural-functional relationship studies have been critical in understanding diabetic kidney disease (DKD) evolution. However, most such studies were performed in persons with type 1 diabetes, where diabetic glomerular lesions are strongly associated with albumin excretion rate (AER). Here, we compare DKD structural-functional relationships in type 1 and type 2 diabetes.

methodsTo better understand the evolution of DKD in type 2 diabetes, analyses of glomerular structure/albuminuria relationships were performed in 133 research volunteers with type 2 and 161 with type 1 diabetes matched for AER compared to 95 living donor kidney biopsies as controls.

resultsMorphometric measures of DKD glomerular lesions were more advanced and showed stronger relationships with AER in persons with type 1 vs type 2 diabetes. K-means cluster analysis based on distance from a structural-functional relationship model derived from data of research participants with type 1 diabetes yielded two clusters: 74% of participants with type 2 diabetes were in Cluster 1, which also included most participants with type 1 diabetes, while 26% of participants with type 2 diabetes (39% of type 2 cases with increased AER) were in Cluster 2 and showed greater AER than predicted by their DKD glomerular lesions based on the model. Among those with type 2 diabetes, despite excessive AER in Cluster 2, DKD glomerular lesions and podocyte structural parameters were similar between the two clusters. However, adjusted for AER, individuals with type 2 diabetes in Cluster 1 had more severe DKD lesions and approximately four-fold greater rates of glomerular filtration rate decline over nine to ten years follow up than those in Cluster 2.

conclusionsKidney structural-functional relationships are heterogeneous in individuals with type 2 diabetes, and this heterogeneity is linked to glomerular filtration rate loss over time. Our investigation calls for further studies to better understand factors involved in this heterogeneity.

Indexed as

AlbuminuriaDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2Diabetic NephropathiesKidney GlomerulusAdultAgedBiopsyCase-Control StudiesCluster AnalysisDisease ProgressionFemaleGlomerular Filtration RateHumansMaleMiddle Agedalbuminuriabiopsydiabetesdiabetic nephropathymorphometry

Identifiers

PMID41061855
PMCPMC12918777

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