Clinical and pathological characteristics of non-diabetic renal disease in type 2 diabetes patients

Abstract

BackgroundRenal involvement in type 2 diabetes is mainly due to diabetic nephropathy (DN). Nevertheless, a sizable proportion of diabetic patients could actually have nondiabetic renal diseases (NDRDs) or DN plus NDRDs. This study aimed to explore the pathological features of NDRD in diabetic patients and to assess the predictability of diagnosing NDRD (±DN) versus isolated DN on the basis of clinical parameters.MethodsMedical records of type 2 diabetes patients who underwent renal biopsy under suspicion of NDRD from January 2011 through November 2015 were analyzed retrospectively.ResultsA total of 101 patients were enrolled in this study. The most frequent indication for renal biopsy was recent onset of nephrotic syndrome (41%), followed by rapidly progressive renal failure (29%) and active urinary sediment (21%). On renal biopsy, 51% of patients had isolated DN, 20% had isolated NDRD and 29% had DN plus NDRD. IgA nephropathy was the most common cause of isolated NDRD, whereas acute tubular necrosis (39%) and acute interstitial nephritis (33%) were the main causes of NDRD superimposed on DN. Male gender, short-duration diabetes (<8 years), lower glycated hemoglobin and active urinary sediment (≥10 red and white blood cells per high-power field) were independent predictors of NDRD according to multiple logistic regression analysis.ConclusionsJudicious use of renal biopsy revealed NDRD (±DN) in nearly half of type 2 diabetes patients with atypical renal presentation, especially in male patients with well-controlled diabetes, those who have had diabetes for a short duration and those with active urinary sediment.

Clinical prediction score for diagnosing non-diabetic renal disease in patients with type 2 diabetes mellitus: a cohort study

“…Higher renal function was found to be a signi cant predictor in a recent study [9], showing eGFR ≥90 ml/min/1.73m 2 had OR of 6.38 (95% CI, 1.58-25.7). High HbA1c or fasting blood sugar were reported in a few studies [5,7]. Unlike previous reports [6, 9, 15], we could not nd any association of proteinuria levels with NDRD as the majority of our population already had macroalbuminuria.…”

“…Previous studies have only reported predictors, such as absence of DR, duration of diabetic mellitus (DM), degrees of proteinuria, Hemoglobin A1c (HbA1c), or levels of creatinine or GFR associated with NDRD, but none have mentioned the utility of a combined predictive probability [3,[7][8][9]. A clinical prediction score combines predictors in the model, informs clinicians and patients about disease probability, and can aid in decision-making [10].…”

Timing of kidney biopsy in type 2 diabetic patients: a stepwise approach

“…However, it's difficult to define the onset of type 2 DM accurately; therefore, the known duration is less strongly related to DN [17,25]. Several studies still showed that DM duration was shorter in type 2 DM patients with NDRD than patients with DN [19,20,[28][29][30][31][32]. In our study, patients with NDRD ± DN had a shorter duration of DM than patients with isolated DN (Table 1).…”

“…The difference in DM duration might come from patients without diabetic retinopathy, and the duration of DM is also a factor predicting the presence of NDRD within this subgroup. The presence of hematuria has been considered as one of the atypical features suggesting the presence of NDRD in the previous guidelines [25] and reports [16,28,30,[32][33][34][35][36][37]. However, there are also some studies suggesting that hematuria is not an uncommon finding in patients with typical DN (between 35 and 78%) and thus is not useful in predicting NDRD [38][39][40][41].…”

Incidence, Risk Factors, and Outcomes of Transition of Acute Kidney Injury to Chronic Kidney Disease in Cirrhosis: A Prospective Cohort Study

“…(14) The tubulointerstitial changes in diabetic nephropathy are thought to be related to the renal microvasculature alterations, and it is generally held that they are attributed to chronic ischemia or hypoxia. (14) IHC studies of the kidney biopsies showed apoptotic pathology in the renal tubules. The outcome of renal tubular injury could be apoptosis of epithelial cells with mild injury and necrosis if the insult is severe.…”