Clinical features of non-diabetic renal diseases in patients with type 2 diabetes

Tone, Atsuhito; Shikata, Kenichi; Matsuda, Mitsuhiro; Usui, Hitomi; Okada, Shinichi; Ogawa, Daisuke; Wada, Jun; Makino, Hírofumi

doi:10.1016/j.diabres.2005.02.009

Cited by 120 publications

(132 citation statements)

References 15 publications

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“…Our results are an important addition to previously reported data from smaller cohorts on biopsy findings in (1,2), the majority of reports have suggested that a higher degree of proteinuria is found in DN than in NDRD (3,4,8,10,11).…”

Section: Discussionsupporting

confidence: 52%

“…The value of such serologic testing in predicting NDRD has not been reported by others (1)(2)(3)(4)8,10,11). In our cohort, although the finding of any positive serologic test performed at the time of biopsy was not predictive of NDRD, the specific findings of low complement levels (low C3 and/or low C4) and M-spike in either serum or urine, on univariate analyses, were associated with NDRD on biopsy.…”

Section: Discussioncontrasting

confidence: 45%

“…The overwhelming majority of these diagnoses would yield some change in treatment, ranging from the use of immunosuppression to titration of renin-angiotensinaldosterone system blockade. The most common NDRDs previously reported in patients with DM are IgAN (3,(11)(12)(13), FSGS (1,10), and MGN (10,14). In our series, FSGS was the most common finding in NDRD alone, identified in 48 patients (22%) and, in all but 6 patients, read as secondary or adaptive FSGS related to such comorbidities as obesity and systemic hypertension.…”

Section: Discussionmentioning

confidence: 66%

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The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

Sharma

Bomback

Radhakrishnan

et al. 2013

Clinical Journal of the American Society of Nephrology

264

233

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SummaryBackground and objectives Renal biopsies performed in diabetic patients are increasing in number and complexity. This study sought to determine the usefulness of renal biopsy in patients with diabetes and the predictability of diagnosing diabetic nephropathy (DN) versus nondiabetic renal disease (NDRD) from clinical and laboratory data.Design, setting, participants, & measurements To assess modern trends, a retrospective study was performed of clinical-pathologic findings in all patients with diabetes who had a biopsy in 2011. Among 2642 native kidney biopsies, 620 (23.5%) were from patients with diabetes.Results The cohort included 371 men (60.7%) aged a median (interquartile range) 62 years (52-69) with 10-year (5-15) duration of diabetes mellitus (DM). Median serum creatinine was 2.5 mg/dl (1.6-4.4), and 52% of patients had stage 4-5 CKD. On biopsy, 37% of patients had DN alone, 36% had NDRD alone, and 27% had DN plus NDRD. In NDRD alone, FSGS (22%), hypertensive nephrosclerosis (18%), acute tubular necrosis (ATN) (17%), IgA nephropathy (11%), membranous GN (8%), and pauci-immune GN (7%) comprised 80% of diagnoses, compared with ATN (43%), hypertensive nephrosclerosis (19%), FSGS (13%), and IgA nephropathy (7%) for DN plus NDRD. In multivariate analyses, longer duration of DM was associated with a greater likelihood of DN and a lower likelihood of NDRD: each added year of DM reduced the odds of NDRD by 5% (odds ratio, 0.95; 95% confidence interval, 0.91 to 0.98; P=0.004). DM duration $12 years was the best predictor (58% sensitivity, 73% specificity) of DN alone.Conclusions Approximately one-quarter of all renal biopsies are performed in patients with DM. Judicious use of renal biopsy has uncovered NDRD alone or superimposed on DN in the majority of such biopsies. ATN is emerging as an important category of NDRD, which has not been reported previously.

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Section: Discussionsupporting

confidence: 52%

Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 66%

See 1 more Smart Citation

The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

Sharma

Bomback

Radhakrishnan

et al. 2013

Clinical Journal of the American Society of Nephrology

264

233

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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Background: Renal involvement in type 2 diabetes is mostly due to diabetic nephropathy (DN), but a subset of diabetic patients could present with pure non-diabetic renal disease (NDRD) or NDRD superimposed on DN. We conducted a prospective cohort study to identify the underline renal pathology in type 2 diabetic patients with defined clinical criteria for renal biopsy.Methods: A total of 46 patients (27 female, mean age of 48.9 ± 11.9 years) with type 2 diabetes mellitus (DM) and atypical features of DN with unexpected proteinuria, hematuria, and/or renal impairment were enrolled in this study. Results: Of 46 patients with type 2 diabetes, 16 (34.8%) had DN, 20 (43.5%) had NDRD, and 10 (21.7%) had NDRD superimposed on DN. Membranous nephropathy (34%) was the most common NDRD. Patients with NDRD had a lower frequency of diabetic retinopathy (5%), shorter duration of diabetes, higher range of proteinuria, and better kidney survival. In multiple logistic regression analysis, only lack of diabetic retinopathy was independent predictor of NDRD. Positive and negative predictive value of diabetic retinopathy (DR) for diabetic nephropathy was 94 and 68%, respectively. Conclusion: Kidney biopsy is strongly recommended for patients with type 2 diabetes and atypical renal presentation for DN, particularly in the absence of DR. This approach could lead to diagnosis of NDRD with better renal survival.

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“…In type 2 diabetes, the issue may be more complex, and renal biopsy may be the only way to distinguish the nature of the renal disease in patients with hyperglycemia and proteinuria that is similar to our syndromic patients. This is well established in a recent Japanese study in which other forms of nephropathy were seen on renal biopsy in addition to or instead of DN (39). Although short duration of diabetes (Ͻ5 yr) or absence of diabetic retinopathy favors a diagnosis other than DN, this is complicated by the lack of information on the onset of hyperglycemia in patients with type 2 diabetes and the known discordance with retinopathy.…”

Section: Discussionmentioning

confidence: 92%

Spectrum of Renal Diseases Associated with Extreme Forms of Insulin Resistance

Musso

Javor

Cochran

et al. 2006

Clinical Journal of the American Society of Nephrology

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Diabetic nephropathy is the leading cause of ESRD in the United States. Why the pathogenic mechanisms lead to nephropathy in certain patients with type 1 and 2 diabetes and spare others is unclear, but it is clear that hyperglycemia and glomerular hyperfiltration are important factors. In patients with syndromes of extreme insulin resistance, proteinuric forms of renal disease are common, but it is surprising to find that the renal pathology usually is not diabetic nephropathy. For instance, in the lipodystrophy syndromes, membranoproliferative glomerulonephritis type 1 and type 2, focal segmental glomerulosclerosis, and also diabetic nephropathy are seen. In the syndromes of autoantibodies to the insulin receptor, the various forms of lupus glomerulonephritis are seen. Even in patients with type 2 diabetes, the renal pathology may not be diabetic nephropathy. Therefore, in patients with syndromic forms of insulin resistance and type 2 diabetes, renal biopsy has an important role in defining the pathology that leads to proteinuric nephropathy and in formulating a therapeutic approach. It is the purpose of this article to review these unusual aspects of proteinuric nephropathy in patients with diabetes.

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Clinical features of non-diabetic renal diseases in patients with type 2 diabetes

Cited by 120 publications

References 15 publications

The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

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

Spectrum of Renal Diseases Associated with Extreme Forms of Insulin Resistance

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