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Henry Ford Hospital Medical Journal

Abstract

To better understand renal dysfunction in type 2 diabetes mellitus, we studied the clinical and autopsy findings in comparable cohorts of 108 diabetic and 77 nondiabetic patients. In the diabetic group, no differences were noted between black and white patients in blood glucose concentrations, mean blood pressure, or the prevalence of diabetic glomerulosclerosis. However, the prevalence of renal insufficiency was significantly greater (P = 0.002) in black diabetics (58%) than in white diabetics (35%). black controls (28%), and white controls (20%). Logistic regression analysis demonstrated a significant association of renal insufficiency with diabetes (P = 0.006) and race (P = 0.032). butnot with mean blood pressure, age, or sex. An additional nonspecific glomerular lesion commonly found was global sclerosis. The occurrence of this lesion was significantly greater (P = O.OOI) in black diabetics (42% ± 5%) than in white diabetics (26% ± 5%), black controls (19% ± 4%), and white controls (21% ± 4%), and was highly correlated (P = O.OOI) to serum creatinine concentrations. In patients with serum creatinine concentrations lower than 1.6 mg/dL, kidney weight was significantly greater (P = 0.03) in diabetics with diabetic glomerulosclerosis (405 ± 32 g) as compared to those without it (300 ± 25 g) or to control patients (329 ± 13 g). This study demonstrates that the overall prevalence of diabetic glomerulosclerosis in this group of type 2 diabetics is 45%, and that renal enlargement is present in these patients prior to the development of significant renal insufficiency. In addition, renal insufficiency and end-stage renal failure are more common in black than in white diabetics.

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