Correlation Analysis between Extracapillary Hypercellularity, Segmental Sclerosis, and Clinical Features of Diabetic Nephropathy

Background: Extracapillary hypercellularity(EXHC) and segmental sclerosis(SS) were poor prognostic features of diabetic nephropathy(DN). We stated the difference of EXHC and SS, and analyzed the correlation between EXHC or SS and clinical features. We also evaluated the pathological significance of EXHC and SS and studied the cellular origin of the EXHC structure. Methods: Clinical and pathological information was collected from 115 biopsy-proven DN patients from 2021 to 2023. Welch t test, Chi-square test or Mann-Whitney U test was used to compare the difference. Correlation analysis was conducted using Spearman correlation analysis. The cellular component of EXHC was shown by immunofluorescence. Results: The number of patients with EXHC and SS structure was 44 and 79,respcetively. There was significant difference in height between patients with EXHC and those without. There was significant difference in urea nitrogen, uric acid, 24-h proteinuria, urinary protein/creatinine ratio, urinary albumin/creatinine ratio, diabetic retinopathy in patients with SS compared with those without. A positive correlation was found between the number of EXHC and patients' height. Correlation analysis revealed that SS correlated with serum creatinine, e-GFR, urea nitrogen, 24-h proteinuria, urinary protein/creatinine ratio, urinary albumin/creatinine ratio, and diabetic retinopathy. Most of the EXHC structure consisted of Claudin-1 positive glomerular parietal epithelial cells and a little was WT1 positive podocytes. Conclusion: We found in DN patients with SS, the level of serum creatinine, proteinuria, diabetic retinopathy and low e-GFR was higher than patients without SS. Although EXHC associated with height, the finding that podocytes were observed in the EXHC structure suggested that they may play a role in the formation of the unique structure.Immunofluorescence staining for Claudin-1(green), WT1(red) in DN patients with EXHC.