Division of Nephrology, Peking University First Hospital, Beijing, 100034, PR China; Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, 518000, PR China.
Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, 518000, PR China.
Diabetes Metab. 2024 Jul;50(4):101547. doi: 10.1016/j.diabet.2024.101547. Epub 2024 Jun 7.
Podocyte injury plays an essential role in the progression of diabetic nephropathy (DN). The associations between the ultrastructural changes of podocyte with proteinuria and the pathological classification of DN proposed by Renal Pathology Society (RPS) have not been clarified in patients with type 2 diabetic nephropathy (T2DN).
We collected 110 patients with kidney biopsy-confirmed T2DN at Peking University First Hospital from 2017 to 2022. The morphometric analysis on the podocyte foot process width (FPW) and podocyte detachment (PD) as markers of podocyte injury was performed, and the correlations between the ultrastructural changes of podocytes with severity of proteinuria and the RPS pathological classification of DN were analyzed.
Mean FPW was significantly broader in the group of T2DN patients with nephrotic proteinuria (565.1 nm) than those with microalbuminuria (437.4 nm) or overt proteinuria (494.6 nm). The cut-off value of FPW (> 506 nm) could differentiate nephrotic proteinuria from non-nephrotic proteinuria with a sensitivity of 75.3% and a specificity of 75.8%. Percentage of PD was significantly higher in group of nephrotic proteinuria (3.2%) than that in microalbuminuria (0%) or overt proteinuria (0.2%). FPW and PD significantly correlated with proteinuria in T2DN (r = 0.473, p < 0.001 and r = 0.656, P < 0.001). FPW and PD correlated with RPS pathological classification of T2DN (r = 0.179, P = 0.014 and r = 0.250, P = 0.001). FPW value was increased significantly with more severe DN classification (P for trend =0.007). The percentage of PD tended to increase with more severe DN classification (P for trend = 0.017).
Podocyte injury, characterized by FPW broadening and PD, was associated with the severity of proteinuria and the pathological classification of DN.
足细胞损伤在糖尿病肾病（DN）的进展中起着至关重要的作用。然而，在 2 型糖尿病肾病（T2DN）患者中，足细胞超微结构改变与蛋白尿之间的关系以及肾脏病理学会（RPS）提出的 DN 病理分类尚未得到明确。
我们收集了 2017 年至 2022 年在北京大学第一医院经肾活检证实的 110 例 T2DN 患者。对足细胞足突宽度（FPW）和足细胞脱落（PD）作为足细胞损伤标志物的形态计量学分析，并分析了足细胞超微结构变化与蛋白尿严重程度和 RPS 病理分类的相关性。
T2DN 患者中，肾病性蛋白尿组（565.1nm）的平均 FPW 明显宽于微量白蛋白尿组（437.4nm）或显性蛋白尿组（494.6nm）。FPW（>506nm）的截断值可以将肾病性蛋白尿与非肾病性蛋白尿区分开来，其灵敏度为 75.3%，特异性为 75.8%。肾病性蛋白尿组的 PD 百分比（3.2%）明显高于微量白蛋白尿组（0%）或显性蛋白尿组（0.2%）。在 T2DN 中，FPW 和 PD 与蛋白尿显著相关（r=0.473，P<0.001 和 r=0.656，P<0.001）。FPW 和 PD 与 T2DN 的 RPS 病理分类相关（r=0.179，P=0.014 和 r=0.250，P=0.001）。随着更严重的 DN 分类，FPW 值显著增加（趋势 P=0.007）。PD 的百分比随着更严重的 DN 分类而增加（趋势 P=0.017）。
以 FPW 变宽和 PD 为特征的足细胞损伤与蛋白尿的严重程度和 DN 的病理分类相关。
