Classifying diabetic nephropathy should improve clinical management

A research committee has developed pathological classifications for diabetic nephropathy to create a uniform system to guide patient care, improve communication between clinicians and renal pathologists, and help researchers design better clinical studies.

Diabetic nephropathy is a major cause of end-stage renal disease, and diabetes rates are rising rapidly. While classifications already exist for several other kidney diseases, the group wanted to develop a uniform, easy-to-use classification system for diabetes with specific categories that discriminate lesions.

The consensus group published their classifications online in the Journal of the American Society of Nephrology.

They classified diabetic nephropathy due to type 1 and type 2 diabetes together because of the "substantial overlap" of histologic lesions and renal complications.

The group did not state whether the classifications predict clinical outcomes. Other renal disease classifications do not, and the experts decided validation should be done in separate prospective studies that include protocol biopsies of patients with type 1 and type 2 diabetes who meet clearly defined clinical end points.