Cell and matrix components of the glomerular mesangium in type I diabetes

In a cross-sectional study, glomerular basement membrane (GBM) width, the volume fractions of the mesangium (V_vMes), its cell (V_vCell) and matrix (V_vMatx) components, and surface density of the peripheral capillary surface (S_VPGBM) were measured in renal biopsies from 187 nondiabetic living related and cadaveric donors of kidneys for transplantation and from 150 patients with insulin-dependent (type I) diabetes mellitus of 1-41 yr duration. In the diabetic patients, the matrix was the major factor in the expansion of the mesangium. However, both V_vCell (0.11 ± 0.04) and V_vMatx (0.20 ± 10) in diabetic patients exceeded the same measurements in nondiabetic subjects (0.07 ± 0.02 for each component) (P < 0.001 in each case). Linear regression analysis demonstrated significant correlations (P < 0.001 for all) between GBM width, V_vMes, V_vCell, V_vMatx, or S_vPGBM and either urinary albumin excretion and creatinine clearance, with the higher correlation coefficients in all cases with albuminuria. Of the structural parameters, V_vMatx correlated best with either functional measure by stepwise regression, with GBM as an added factor only with albuminuria. Therefore, although models of diabetic glomerulopathy must consider enlargement of both mesangial cells and matrix, the predominant factor in the progression of structural and functional renal disease is mesangial matrix expansion.