Ultrastructural changes of platelets in patients with diabetes mellitus type 1 and 2 depending on the state of renal function at different stages of chronic renal failure

Abstract

The aim of our study was to study the ultrastructural changes of platelets in patients with diabetes mellitus type 1 (T1DM) and type 2 (T2DM) depending on estimated glomerular filtration rate (eGFR) and to assess the possibility of their use as an early marker of diabetic kidney disease progression. Materials and methods. The study included 37 people: 15 patients with T1DM, 15 with T2DM, 7 healthy volunteers. Patients were divided into three groups depending on eGFR: group 1 – eGFR ≥90 ml/min/1.73 m²; group 2 – eGFR 89–60 ml/min/1.73 m²; group 3 – eGFR 59–45 ml/min/1.73 m². Transmission electron microscope PEM-100-01 “SELMI” (Ukraine) was used to determine the ultrastructural changes of platelets. Results. We studied ultrastructural changes of platelets in patients with T1DM and T2DM depending on eGFR and determined the changes in platelet hemostasis in patients with eGFR ≥90 ml/min/1.73 m². We proved that the higher damage degree of kidneys filtration function leads to the worse platelets membrane structures damage, increased number of platelet hyperactivation signs, higher proportion of irreversibly transformed cells. Conclusion. Morphological substrate of platelet hemostasis damage in patients with T1DM and T2DM is increased destabilization of the platelet membranes, massive agglutination with a predominance of various sizes condensed aggregates, the involvement of irreversibly deformed erythrocytes and activated leukocytes in their composition, imbalance of density packing of alpha-, delta-, and lambda- granules. This ultrastructural complex can be considered as an early marker of diabetic kidney disease progression in patients with T1DM and T2DM.

Keywords

• platelet hemostasis
• diabetes mellitus 1 and 2 type
• estimated glomerular filtration rate