Morphological changes of the kidneys according to autopsy data of persons with type 2 diabetes mellitus and arterial hypertension

The morphological picture of the kidneys in patients with type 2 diabetes mellitus (DM) and arterial hypertension (AH) was studied according to autopsy data, and the results were compared with the structural features of the kidneys of persons suffering from AH without diabetes. A morphological study of kidney tissue was carried out in 30 persons (27 women and 3 men) aged 51 to 86 years, suffering from type 2 diabetes and hypertension, who died from acute cardiovascular failure in the intensive care unit of the general hospital of the State Clinical Hospital No. 9 (Saratov ) in 2017–2018. The duration of type 2 diabetes ranged from newly diagnosed diabetes to 30 years. The comparison group consisted of the results of autopsies of 10 individuals (9 women and 1 man) with AH without diabetes at the age of 50 to 80 years, whose cause of death was also acute cardiovascular failure. In the course of the morphological study of the kidneys in patients with type 2 diabetes mellitus and arterial hypertension, nephropathy of hypertensive genesis was diagnosed in 93.3% of cases, in 60% – a combination of diabetic and hypertensive nephropathy, in 33% – isolated hypertensive nephropathy. Comparison of morphological and clinical diagnoses of nephropathy revealed underdiagnosis of the latter on an outpatient basis. 

1. Smirnov A. V., Dobronravov V. A., Kisina A. A., Rumyantsev A. Sh., Kayukov I. G. Programma nepreryvnogo poslediplomnogo obrazovaniya po nefrologii. Klinicheskiye rekomendatsii po diagnostike i lecheniyu diabeticheskoy nefropatii [Program of continuous postgraduate education in nephrology. Clinical guidelines for the diagnosis and treatment of diabetic nephropathy] Nefrologiya. 2015. T. 19. № 1. Pp. 67–77.

2. Markova T. N., Sadovskaya V. V., Bespyatova M. Yu. Sovremennyye vozmozhnosti diagnostiki khronicheskoy bolezni pochek pri sakharnom diabete [Modern possibilities of diagnosing chronic kidney disease in diabetes mellitus] Sakharnyy diabet. 2017. T. 20. № 6. Pp. 454–460.

3. Zharikov A. Yu., Shchekochikhina R. O. Diabeticheskaya nefropatiya. Sovremennyy vzglyad na problemu [Diabetic nephropathy. Modern view of the problem] Byulleten’ meditsinskoy nauki. 2018. T. 10. № 2. Pp. 24–31.

4. Zachary T., Bloomgarden M. D. Blood Pressure and Diabetic Nephropathy // Diabetes Care. 2010. V. 33. № 3. P. 30–35.

5. Ametov A. S. Sakharnyy diabet 2 tipa. Problemy i resheniya [Diabetes mellitus type 2. Problems and solutions] ucheb. pos. 2-ye izd., pererab. i dop. M.: GOETAR-Media, 2014. Pp. 509–521.

6. Oslozhneniya sakharnogo diabeta: lecheniye i profilaktika [Complications of Diabetes Mellitus: Treatment and Prevention] Pod red. akad. RAN I. I. Dedova, akad. RAN M. V. Shestakovoy. M.: OOO «Izdatel’stvo Meditsinskoye informatsionnoye agentstvo», 2017. Pp. 190–194.

7. Poteshkina N. G., Mirina Ye. Yu. Lecheniye arterial’noy gipertenzii pri sakharnom diabete [Treatment of arterial hypertension in diabetes mellitus] RMZH. 2010. № 9. P. 565.

8. Viswanathan V., Tilak P., Kumpatla S. Risk factors associated with the development of overt nephropathy in type 2 diabetes patients: a 12 years observational study // Indian J Med Res. 2012. V. 136. № 1. P. 46–53.