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Previous Volume 339:69-75 July 9, 1998 Number 2 Next

	Full Text PDF Editorial by Luzi, L. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background In patients with type 1 diabetes mellitus who do not have uremia and have not received a kidney transplant, pancreas transplantation does not ameliorate established lesions of diabetic nephropathy within five years after transplantation, but the effects of longer periods of normoglycemia are unknown.

Methods We studied kidney function and performed renal biopsies before pancreas transplantation and 5 and 10 years thereafter in eight patients with type 1 diabetes but without uremia who had mild to advanced lesions of diabetic nephropathy at the time of transplantation. The biopsy samples were analyzed morphometrically.

Results All patients had persistently normal glycosylated hemoglobin values after transplantation. The median urinary albumin excretion rate was 103 mg per day before transplantation, 30 mg per day 5 years after transplantation, and 20 mg per day 10 years after transplantation (P=0.07 for the comparison of values at base line and at 5 years; P=0.11 for the comparison between base line and 10 years). The mean (±SD) creatinine clearance rate declined from 108±20 ml per minute per 1.73 m² of body-surface area at base line to 74±16 ml per minute per 1.73 m² at 5 years (P<0.001) and 74±14 ml per minute per 1.73 m² at 10 years (P<0.001). The thickness of the glomerular and tubular basement membranes was similar at 5 years (570±64 and 928±173 nm, respectively) and at base line (594±81 and 911±133 nm, respectively) but had decreased by 10 years (to 404±38 and 690±111 nm, respectively; P<0.001 and P=0.004 for the comparisons with the base-line values). The mesangial fractional volume (the proportion of the glomerulus occupied by the mesangium) increased from base line (0.33±0.07) to 5 years (0.39±0.10, P=0.02) but had decreased at 10 years (0.27±0.02, P=0.05 for the comparison with the base-line value and P=0.006 for the comparison with the value at 5 years), mostly because of a reduction in mesangial matrix.

Conclusions Pancreas transplantation can reverse the lesions of diabetic nephropathy, but reversal requires more than five years of normoglycemia.

Source Information

From the Department of Internal Medicine and the Center for the Study of Aging of the National Research Council, University of Padua Medical School, Padua, Italy (P.F.); and the Departments of Laboratory Medicine and Pathology (M.W.S.), Surgery (D.E.R.S.), Medicine (F.C.G.), and Pediatrics (M.M.), University of Minnesota School of Medicine, Minneapolis.

Address reprint requests to Dr. Mauer at the Department of Pediatrics, University of Minnesota, Box 491, UMHC, 420 Delaware St. S.E., Minneapolis, MN 55455-0392, or Dr. Fioretto at the Department of Internal Medicine, University of Padua, Via Giustiani, No. 2, Padua 35128, Italy.

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