Classification and Differential Diagnosis of Diabetic Nephropathy

Abstract

Diabetic nephropathy (DN) is a major cause of end-stage renal disease throughout the world in both developed and developing countries. This review briefly introduces the characteristic pathological changes of DN and Tervaert pathological classification, which divides DN into four classifications according to glomerular lesions, along with a separate scoring system for tubular, interstitial, and vascular lesions. Given the heterogeneity of the renal lesions and the complex mechanism underlying diabetic nephropathy, Tervaert classification has both significance and controversies in the guidance of diagnosis and prognosis. Applications and evaluations using Tervaert classification and indications for renal biopsy are summarized in this review according to recent studies. Meanwhile, differential diagnosis with another nodular glomerulopathy and the situation that a typical DN superimposed with a nondiabetic renal disease (NDRD) are discussed and concluded in this review.

Obesity-Related Glomerulopathy: A Latent Change in Obesity Requiring More Attention

“…Given the severity of glomerulosclerosis in hypertension-related kidney disease, patients with hypertension as well as obesity whose biopsy results showed moderate-to-severe vascular lesions associated with glomerular degeneration should be diagnosed as hypertensive glomerulosclerosis rather than ORG [10]. The typical pathological changes of diabetic nephropathy are mesangial expansion and glomerular basement membrane thickening, which are distinctive from the mild and always singly occurring “diabetoid” changes in ORG [11]. Moreover, the differences between obesity-related FSGS and primary FSGS were demonstrated in Table 1 [2].…”

Association between the vitaminDreceptor gene polymorphisms and diabetic nephropathy risk:Ameta‐analysis

“…Diabetic nephropathy (DN), or diabetic kidney disease, is a progressive kidney disease caused by damage to the capillaries in the kidney’s glomeruli, and is characterized by nephrotic syndrome and diffuse scarring of the glomeruli . It is a major cause of morbidity and mortality in people with both type 1 and type 2 diabetes mellitus, and is the leading cause of end‐stage renal disease (ESRD) worldwide, affecting approximately 30–40% of people with diabetes, and 50% of those who start renal dialysis for ESRD each year .…”

IL10 haplotypes are associated with diabetic nephropathy susceptibility in patients from western Mexico

“…46 from the Instituto Mexicano del Seguro Social in Guadalajara, Jalisco, Mexico were recruited and the diagnosis of T2DM was according to ADA criteria . The nephropathy was evaluated based on estimated Glomerular Filtration Rate (eGFR) less than 25 mL/min and proteinuria of 300 mg/24 hour …”