Clinical predictors of non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus

Abstract

Abstractthis setting will not be diagnostically useful. In retrospective studies of non-insulin dependent diabetes melBackground. Several studies had suggested that nondiabetic renal disease (NDRD) was common among litus (NIDDM ) patients with renal involvement, from 12-81% of their renal lesions were non-diabetic renal non-insulin dependent diabetes mellitus (NIDDM ) patients with renal involvement. diseases (NDRD), with different spectrum of diseases identified in different series [4][5][6][7][8][9]. Such retrospective Methods. We prospectively studied the prevalence of NDRD among a Chinese NIDDM population. Renal studies are apparently biased and tend to selectively include patients with clinical presentations thought not biopsy specimens were evaluated with light-, immunohistological and electron-microscopy. The cohort in keeping with diabetic glomerulosclerosis. Also, for patients found to have NDRD, different predicting consisted of 51 patients who had NIDDM and proteinuria >1 g/24 h.factors have been identified in these series, including late age of onset of DM [4], absence of neuropathy Results. Patients with both isolated diabetic nephropathy (DN, n=34) and NDRD (n=17) had compar- [4,5], absence of retinopathy [4,5] and presence of other systemic diseases [4]. However, these factors able duration of DM, creatinine clearance, serum creatinine, albumin and glycosylated haemoglobin were found to have variable predictive values in different series. In a limited number of prospective studies levels, as well as incidences of retinopathy, neuropathy and hypertension. Significantly more patients with of NIDDM patients with renal involvement, from 23-39% of patients were found to have NDRD NDRD had microscopic haematuria (P=0.043) or non-nephrotic proteinuria (P=0.004). IgA nephro- [10][11][12]. However, only the absence of retinopathy and autonomic neuropathy were found to be useful pathy accounted for 59% of the NDRD identified. Conclusions. In this study, microscopic haematuria clinical markers [10]. Overall, it remains unclear whether one is to offer biopsy for all such patients, or and non-nephrotic proteinuria predicted the presence of NDRD among NIDDM patients presenting with should indeed reserve biopsy for those patients with atypical features associated with proteinuria, i.e. renal disease.sudden onset, haematuria, acute renal insufficiency, extra-renal manifestations, and absence of retinopathy Key words: microscopic haematuria; non-diabetic renal disease; non-insulin dependent diabetes mellitus; non- [13]. We have performed a prospective study to clarify the issue in our local population where little data exist. nephrotic proteinuria Subjects and methods Patients

Dysmorphic erythrocytes are superior to hematuria for indicating non‐diabetic renal disease in type 2 diabetics

“…The incidence of hematuria was 32.3–78% in renal biopsy studies of patients with type 2 diabetes mellitus and proteinuria6, 7, 8. More importantly, hematuria had low specificity for the diagnosis of NDRD25. The incidence of hematuria was 0.69 in our data, consistent with other reports, but was not increased in NDRD patients when compared with isolated DN patients.…”

Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis

“…Different methods were used to assess DR: ophthalmoscopy after mydriasis in four studies [21,22,24,30,36]; fundus photography after mydriasis in one study [27]; ophthalmoscopy without mydriasis in four studies [15,23,26,28,29,33,34,40]; and in nine studies no relevant details were provided [8, 10, 25, 31-33, 35, 38, 39]. Of the nine prospective studies assessed, five were screening studies conducted on consecutive patients with type 2 diabetes mellitus and proteinuria [21][22][23][24][25], while the remaining four were conducted on selected type 2 diabetes mellitus populations using criteria for the biopsy for type 1 diabetes mellitus (microhaematuria, absence of DR, atypical change in renal function, or immunological abnormalities) [26][27][28][29]. However, in most DR predicting DN Forest plots of the pooled sensitivity and specificity are shown in Fig.…”

“…For instance, studies included patients with microalbuminuria (20-200 mg/day) [21], macroalbuminuria with ranges defined as from >300 mg/day to >3 g/day [9, 14, 15, 22-29, 31, 34, 36-39], or not defined clearly. In addition, there was significant diversity in the methods used to assess DR, and only seven studies applied gold standards for DR screening [21,22,24,27,30,36,37,43]. A third issue was the different categories of renal pathology between studies.…”

Renal biopsy in diabetic patients (experience of Nephrology Department of Clinic for Internal Diseases UCC Banjaluka)

“…Udio nedijabetesne bubrežne bolesti kod bolesnika sa dijabetesom u više objavljenih studija je različit [2][3][4][5][6][7][8][9] (Tabela 2).…”