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Background: Glomerular podocyte number declines and urinary excretion of podocytes increases as kidney disease progresses in persons with type 2 diabetes mellitus (T2DM)., Methods: Using high-power electron microscopy, we quantified podocyte detachment in T2DM., Results: We evaluated 106 glomeruli (range 1-6 per subject) from 40 Pima Indian subjects with T2DM enrolled in a clinical trial. On high-power electron micrographs, 35% of the subjects had no evidence of podocyte detachment. Among the remaining subjects, the median percentage of basement membrane with podocyte detachment was 0.62% (interquartile range = 0.32-1.52%)., Conclusion: Podocyte detachment from the glomerular basement membrane has been described and measured in type 1 diabetes mellitus using a different method. We now document podocyte detachment microscopically and quantify it morphometrically in humans with T2DM. The findings offer quantitative histologic support to a potential mechanism for the functional impairment, and possibly the sclerosis of glomeruli, in diabetic glomerular injury., (Copyright © 2011 S. Karger AG, Basel.)

Chronic kidney disease patients are complex, and usually have multiple comorbid conditions. It is evident that a CKD clinic can improve clinical outcomes and patient satisfaction. It is widely recognized that education, patient empowerment, early recognition of the disease, and appropriate and timely interventions in patients with CKD can positively influence the clinical outcomes in this population. So why is it so difficult to deliver CKD care?