The Development of Lesions in the Glomerular Basement Membrane and Mesangium After Transplantation of Normal Kidneys to Diabetic Patients
- S Michael Mauer,
- Michael W Steffes,
- John Connett,
- John S Najarian,
- David E R Sutherland and
- Jose Barbosa
- Departments of Pediatrics, Laboratory Medicine and Pathology, Biometry, Surgery, and Medicine, University of Minnesota Medical School Minneapolis, Minnesota
- Address reprint requests to Dr. S. Michael Mauer, Pediatrie Nephrology, University of Minnesota Medical School, Box 491 Mayo Memorial Building, 420 Delaware Street S.E., Minneapolis, Minnesota 55455.
Renal allograft biopsies at the time of transplantation (baseline) and 2 yr later were obtained in 6 type 1 diabetic and 12 nondiabetic patients and studied for glomerular basement membrane (GBM) and mesangial changes. Diabetic patients had significantly greater GBM thickness compared with nondiabetics at 2 yr (P = 0.05, rank sum test), and the increase in GBM thickness comparing baseline and 2-yr biopsies was greater in the diabetic compared with nondiabetic patients (P = 0.005, rank sum test). Similarly, diabetic patients developed significant mesangial thickening by light microscopy while no changes were observed in nondiabetic patients (P = 0.001). Electron microscopic morphometric analysis of the percentage of total mesangium was not different on comparing diabetic and nondiabetic patients at 2 yr. There was an increase in the matrix component of the mesangium in the diabetics at this time, although this did not reach statistical significance (P = 0.06). In addition, the surface density of the peripheral glomerular capillary wall, presumably reflecting mesangial expansion, was decreased in the diabetic and unchanged in the nondiabetic patients (P = 0.005). These studies document, for the first time, the development of GBM and mesangial lesions of diabetic nephropathy in normal living related donor and cadaver kidneys transplanted into diabetic patients and support the hypothesis that these lesions are secondary to the diabetic state.
- Received October 5, 1982.
- Revision received March 3, 1983.
- Copyright © 1983 by the American Diabetes Association