Arteriolar hyalinosis is related to rapid GFR decline and long-standing GFR changes observed on renal biopsies in normo-microalbuminuric type 2 diabetic patients

•The present study investigated the relationship of renal arteriolar hyalinosis and rapid GFR decline in normo-microalbuminuric type 2 diabetes patients based on renal biopsy results.•The index of arteriolar hyalinosis (IAH) in the rapid GFR decliners was significantly larger than in the non-rapid decliners.•The IAH showed significant negative correlations with the annual rate of GFR decline and significant positive correlations with the annual rate of UAE increase.•Aggravated arteriolar hyalinosis was a risk factor for a rapid GFR decline and an initial change in early diabetic nephropathy.