Introduction: The clinical-histologic correlation in diabetic nephropathy is not completely known. Methods: We analyzed nephrectomy specimens from 90 patients with diabetes and diverse degrees of proteinuria and glomerular filtration rate (GFR). Results: Thirty-six (40%) subjects had normoalbuminuria, 33 (37%) microalbuminuria, and 21 (23%) non-nephrotic proteinuria. Mean estimated GFR (eGFR) was 65±23 (40% <60 ml/min per 1.73 m2). About 170 glomeruli per patient were analyzed, and all samples included vascular tissue. Six subjects (7%) were classified in diabetic nephropathy class I, 61 (68%) in class II-a, 13 (14%) in class II-b, 9 (10%) class III, and 1 (1%) in class IV. Eighty percent to 90% of those with normoalbuminuria or microalbuminuria were classified in class II-a or II-b and <10% in class III; 52% of those with proteinuria were in class II-a, 15% in class II-b, and 19% in class III. Nodular sclerosis (57%) and mesangial expansion (15%) were more frequent in cases with proteinuria than in normoalbuminuria (28% and 8%; P = 0.028 and 0.017). About 20% to 30% of all cases, regardless the level of albuminuria or proteinuria or the histologic class had tubular atrophy, interstitial fibrosis, or inflammation in >10% to 20% of the sample. Moderate hyalinosis and arteriolar sclerosis were observed in 80% to 100% of cases with normoalbuminuria, microalbuminuria, proteinuria, as well as in class I, II, or III. Conclusions: Weak correspondence between analytical parameters and kidney histology was found. Thus, disease may progress undetected from the early clinical stages of the disease. Finally, vascular damage was a very common finding, which highlights the role of ischemic intrarenal disease in diabetes.

Original languageEnglish
Pages (from-to)2392-2403
Number of pages12
JournalKidney International Reports
Issue number9
StatePublished - Sep 2021

Bibliographical note

Publisher Copyright:
© 2021


This study was funded by the ERA-EDTA ( European Renal Association-European Dialysis and Transplant Association ). This study was funded by the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association). The authors thank the unrestricted support of the ERA-EDTA to the DIABESITY working group and the participants of ENBiBA: The European Nephrectomy Biobank Project (Appendix). FIS/Fondos FEDER (PI17/00257, PI16/01814, PI19/01756, PI18/01386, PI19/00588, PI19/00815, DTS18/00032, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009), Sociedad Española de Nefrología, FRIAT, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. EP had the idea of the study and designed the protocol. RR did the histologic analysis of all samples. All authors collaborated in the design of the protocol. All authors contributed with samples and data of the subjects included in the study. All authors read the final manuscript of the study.

FundersFunder number
Comunidad de Madrid en BiomedicinaB2017/BMD-3686 CIFRA2-CM
European Nephrectomy Biobank Project
Sociedad Española de Nefrología
Federación Española de Enfermedades RarasPI17/00257, PI19/00588, PERSTIGAN AC18/00071, DTS18/00032, ERA-PerMed-JTC2018, PI16/01814, PI19/01756, AC18/00064, ISCIII-RETIC REDinREN RD016/0009, PI19/00815, PI18/01386
European Renal Association-European Dialysis and Transplant Association


    • albuminuria
    • chronic kidney disease
    • diabetes
    • diabetic nephropathy
    • histology
    • normoalbuminuria


    Dive into the research topics of 'The Role of Vascular Lesions in Diabetes Across a Spectrum of Clinical Kidney Disease'. Together they form a unique fingerprint.

    Cite this