A differential diagnostic model of diabetic nephropathy and non-diabetic renal diseases

Abstract

Background. Renal diseases in diabetes include diabetic nephropathies (DN) and non-diabetic renal diseases (NDRD). The clinical differentiation between these two categories is usually not so clear and effective. This study aims to develop a quantified differential diagnostic model. Methods. We consecutively screened the diabetic patients with overt proteinuria but no severe renal failure for kidney biopsy from 1993 to 2003. The finally enrolled 110 patients were divided into two groups according to pathological features (60 in DN group and 50 in NDRD group). Clinical and laboratory data were compared between two groups. Then a diagnostic model was developed based on the logistic regression analysis. Results. Forty-six percent of patients were NDRD including a variety of pathological types. Many differences between DN and NDRD were found by comparison of the clinical indices. In the final logistic regression analysis, only diabetes duration (Dm), systolic blood pressure (Bp), HbA1c (Gh), haematuria (Hu) and diabetic retinopathy (Dr) showed statistical significance. Based on the logistic regression model: π = e z /(1 + e z ), a diagnostic model was constructed as follows: P DN = exp(−13.5922 + 0.0371Dm + 0.0395Bp + 0.3224Gh − 4.4552Hu + 2.9613Dr)/ [1 + exp(−13.5922 + 0.0371Dm + 0.0395Bp + 0.3224Gh − 4.4552Hu + 2.9613Dr)]. P DN was the probability of DN diagnosis (P DN ≥ 0.5 as DN, P DN < 0.5 as NDRD). Validation tests showed that this model had good sensitivity (90%) and specificity (92%).Conclusions. This diagnostic model may be helpful to clinical differentiation of DN and NDRD in type 2 diabetic patients with overt proteinuria.

Non-diabetic renal disease with or without diabetic nephropathy in type 2 diabetes: clinical predictors and outcome

“…These findings are in contrast to reports from Southeast Asia which IgA nephropathy (up to 65%) was the most common NDRD. 5,6 Studies have shown that in the US FGS 14 and in India AIN 7 were the prevail pathology. These contrasting reports in various regions are due to both distinctive common glomerular diseases and perhaps different criteria (and threshold) for kidney biopsy in type 2 diabetes patients with atypical renal presentations.…”

“…[5][6][7][8][9][10][11][12] The most common pathologies in NDRD group were MN (45%) and FGS (30%), respectively. In the DN + NDRD group, although AIN (60%) was the most common lesion, IgA nephropathy (20%) was the prevalent glomerulopathy.…”

“…2,3 Type 2 diabetic patients with proteinuria and diabetic retinopathy (DR) most likely have DN, while high frequency of non-diabetic renal disease (NDRD) has reported in the absence of retinopathy. 4,5 The reported prevalence of NDRD ± DN in diabetes patients is in the range of 17-85% depends upon given institution's biopsy policy and geographic place. [5][6][7][8][9][10][11][12] The importance of NDRD diagnosis is appreciated by the reported better kidney survival following appropriate therapy.…”

“…4,5 The reported prevalence of NDRD ± DN in diabetes patients is in the range of 17-85% depends upon given institution's biopsy policy and geographic place. [5][6][7][8][9][10][11][12] The importance of NDRD diagnosis is appreciated by the reported better kidney survival following appropriate therapy. 10 The atypical clinical features of renal involvement, specially in short duration of diabetes which warrant renal biopsy, are determined due to the absence of diabetic retinopathy, rapidly decreasing renal function, briskly rising proteinuria or acute onset of nephrotic syndrome, and active urine sediment.…”

“…10 The atypical clinical features of renal involvement, specially in short duration of diabetes which warrant renal biopsy, are determined due to the absence of diabetic retinopathy, rapidly decreasing renal function, briskly rising proteinuria or acute onset of nephrotic syndrome, and active urine sediment. [5][6][7][8][9][10][11][12] The present prospective study was carried out to estimate the frequency of NDRD ± DN in type 2 diabetes patients presented with atypical features of diabetic renal involvement. We also investigated the clinical course, renal outcome, and clinical predictors of NDRD.…”