Acid Mucopolysaccharide Changes in Diabetic Kidneys

Studies were conducted on the mucopolysaccharide (MPS) composition of kidneys from seventeen diabetic patients and from six control individuals presumably without renal disease. Thekidney tissues were divided by gross dissection into cortical and medullary portions, and the MPSwere isolated and quantitated from these sections. The contents of hyaluronic acid, heparitin sulfate, and chondroitin sulfates were compared to the clinical and pathological observations on thepatients. According to the MPS pattern of heparitin sulfate and hyaluronic acid, the diabetic kidneys were divided into three groups. Heparitin sulfate was increased fairly consistently in most of the diabetic samples, and was particularly increased in one group with clinically severe diabetes showing the nodular diabetic (Kimmelstiel-Wilson) lesion. Seven of the samples demonstrated a MPS composition somewhat similar to controls, and these were observed to have fewer abnormal changes histologically. A third group showed an increase of hyalufonic acid, and in these kidneys diffuse glomerulosclerosis was the most consistent glomerular lesion. The observations suggest that the two types of specific glomerular lesions found in diabetic kidneys have different cellular origins. The increased heparitin sulfate suggests a relationship of renal changes in diabetes to a vascular origin. A rather interesting similarity of MPS changeshas been observed in amyloidosis and in intima sections of the aorta with atherosclerosis.