Clinical Predictors of Non-diabetic Renal Disease and Role of Renal Biopsy in Diabetic Patients with Renal Involvement: A Single Centre Review

Chong, Yip-Boon; Keng, Tee Chau; Tan, Lian; Ng, Kok-Peng; Kong, Wai-Yew; Wong, C.M.; Cheah, Phaik‐Leng; Looi, Lai‐Meng; Tan, Shouyong

doi:10.3109/0886022x.2011.647302

Cited by 79 publications

(104 citation statements)

References 27 publications

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“…The relatively low screening rates in Korea compared to the Western countries are likely to be due to the difference in the health system, economic situations and national demographics [22]. Chong et al [23] reported the role of renal biopsy in diabetic patients with renal involvement. In the DN subgroup, Indian patients had a significantly shorter duration of diabetes on renal biopsy compared with Malays and Chinese patients.…”

Section: New Biomarkersmentioning

confidence: 99%

The Prevalence and Management of Diabetic Nephropathy in Asia

Tomino

Gohda²

2015

Kidney Dis

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Background: Diabetic nephropathy (DN), especially type 2 diabetes, is now increasing rapidly worldwide, also in Asian countries, and is one of the major long-term vascular complications. The pathogenesis of DN involves both genetic and environmental factors. Around 30-40% of type 2 diabetic patients develop DN despite strict blood glucose and/or blood pressure control. Although it is considered that the genetic background may influence the initiation and progression of DN, the candidate genes are still obscure. Summary: To search for genes that are involved in the susceptibility of DN, a candidate gene approach was taken in the beginning before the development of genome-wide association studies. Although a candidate gene approach can detect rare genetic variants, in advance we need known or presumed pathophysiological knowledge of the specific gene. Investigations using spontaneous animal models are important to determine the pathogenesis and treatment of DN patients. There are many spontaneous animal models, such as the NOD and Akita mice for type 1 diabetes and the Ob/Ob, db/db, Tsumura Suzuki Obese Diabetics, and KK-A^y mice for type 2 diabetes. Furthermore, the toxicity of persistent hyperglycemia, the activation of reactive oxygen species, systemic and/or glomerular hypertension, microinflammation, dyslipidemia, and other factors are considered to play important roles. Diabetic patients with normoalbuminuria and normal renal function showed typical histological patterns of DN. The discovery of a specific and reliable diagnostic and prognostic biomarker other than albuminuria is urgently needed and indispensable. Since large clinical trials of oral hypoglycemic drugs in renal failure are lacking, these recommendations will need to be regularly updated after results of larger randomized trials with longer follow-up durations are available. Key Messages: It is necessary to summarize the basic and clinical features of DN patients in Asia and to use these for the treatment of such patients. Facts from East and West: The prevalence of DN is increasing in Asia and Western countries alike. The deletion (D) allele of the angiotensin-converting enzyme gene is associated with progression to end-stage renal disease in Asian patients with DN, but this association is uncertain in Europeans. An association between DN and polymorphism of the gene coding for acetyl coenzyme A carboxylase β has been reported in Asian and Western populations. Both in Japan and the US, criteria for diagnosis are a 5-year history of diabetes and persistent albuminuria. Renal biopsy should be done in patients with severe hematuria, cellular casts and - in the US - hepatitis and HIV to rule out other pathologies. Diabetic retinopathy is considered a key criterion in Japan, but the absence of it does not rule out DN in the US. Enlargement of the kidney is observed as a diagnostic criterion in Japan. The differential use of renal biopsy as diagnostic tool might account for a different prevalence between Asian countries. Some Japanese diabe...

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Section: New Biomarkersmentioning

confidence: 99%

The Prevalence and Management of Diabetic Nephropathy in Asia

Tomino

Gohda²

2015

Kidney Dis

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“…Information on serum creatinine values was available in 34 studies [6, 7, 9-11, 13, 15-17, 19-21, 23-25, 27-29, 31, 33, 34, 37, 38, 42-48, 50-53]; in 10 of these studies the majority of patients had mean serum creatinine levels falling roughly within the normal range (<1.43 mg/dL) [16, 20, 25, 28, 31, 42-44, 51, 52]. In 12 studies mean values ranged from 1.44 to 3.00 mg/dL [7,10,13,23,25,27,29,34,37,45,47,53] while the remaining 12 included patients with quite severely compromised renal function (serum creatinine >3 mg/dL) [6,9,11,12,15,19,21,24,33,38,46,50]. Data on estimated glomerular filtration rate (eGFR) were available in 16 of the above-mentioned studies reporting information on serum creatinine [7, 10, 13, 15-17, 19-21, 28, 34, 42, 48, 51-53].…”

Section: Study and Participants' Characteristicsmentioning

confidence: 99%

“…FSGS prevailed in six cohorts [12,16,21,32,33,50], (17 [12] to 37.7% [16]). Acute interstitial nephritis was the main NDRD in four studies [9,11,17,24] (18 [24] to 48.8% [11]). The analysis of the different histological pictures of NDRD according to the population background showed a significantly higher percentage of IgA diagnosis in studies on Asian populations compared with European (mean percentage of IgA diagnosis: 21.3 versus 8.2%, P ¼ 0.003) and American studies (21.3 versus 9.4, P ¼ 0.04).…”

Section: Prevalence Of Dn Ndrd and Mixed Forms And Pooled Analysesmentioning

confidence: 99%

Renal biopsy in patients with diabetes: a pooled meta-analysis of 48 studies

Fiorentino

Bolignano²,

Tesař

et al. 2016

Nephrol. Dial. Transplant.

124

131

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Background. The utility of renal biopsy in patients with diabetes is highly debated. Diabetics with rapidly worsening renal disease are often 'clinically' labelled as having diabetic nephropathy (DN), whereas, in many cases, they are rather developing a nondiabetic renal disease (NDRD) or mixed forms (DN þ NDRD). Methods. We performed a systematic search for studies on patients with diabetes with data on the frequency of DN, NDRD and mixed forms, and assessed the positive predictive values (PPVs) and odds ratios (ORs) for such diagnoses by metaanalysing single-study prevalence. Possible factors explaining heterogeneity among the different diagnoses were explored by meta-regression. Results. In the 48 included studies (n ¼ 4876), the prevalence of DN, NDRD and mixed forms ranged from 6.5 to 94%, 3 to 82.9% and 4 to 45.5% of the overall diagnoses, respectively. IgA nephropathy was the most common NDRD (3-59%). PPVs for DN, NDRD and mixed forms were 50.1% [95% confidence interval (CI): 44.7-55.2], 36.9% (95% CI: 32.3-41.8) and 19.7% (95% CI: 16.3-23.6), respectively. The PPV when combining NDRD and mixed forms was 49.2% (95% CI: 43.8-54.5). Metaregression identified systolic pressure, HbA1c, diabetes duration and retinopathy as factors explaining heterogeneity for NDRD, creatinine and glomerular filtration rate for mixed forms and only serum creatinine for DN. ORs of DN versus NDRD and mixed forms were 1.71 (95% CI: 1.54-1.91) and 4.1 (95% CI: 3.43-4.80), respectively. Conclusions. NDRD are highly prevalent in patients with diabetes. Clinical judgment alone can lead to wrong diagnoses and delay the establishment of adequate therapies. Risk stratification according to individual factors is needed for selecting patients who might benefit from biopsy.

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“…NDRD is rare in type 1 diabetes mellitus, particularly in patients with a history of diabetes of >10 years [5]; however, reports of the prevalence of NDRD in type 2 diabetes mellitus have varied widely from 10% to 85% [6][7][8][9][10]. One joint analysis of available data on the prevalence of NDRD among patients with type 2 diabetes mellitus revealed that NDRD was evident on kidney biopsy in ∼22% of European and 26.7% of Asian patients [11].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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Aims/hypothesis The aim of this meta-analysis is to determine the predictive value of diabetic retinopathy in differentiating diabetic nephropathy from non-diabetic renal diseases in patients with type 2 diabetes and renal disease. Methods Medline and Embase databases were searched from inception to February 2012. Renal biopsy studies of participants with type 2 diabetes were included if they contained data with measurements of diabetic retinopathy. Pooled sensitivity, specificity, positive predictive value, negative predictive value and other diagnostic indices were evaluated using a random-effects model. Results The meta-analysis investigated 26 papers with 2012 patients. The pooled sensitivity and specificity of diabetic retinopathy to predict diabetic nephropathy were 0.65 (95% CI 0.62, 0.68) and 0.75 (95% CI 0.73, 0.78), respectively. The pooled positive and negative predictive value of diabetic retinopathy to predict diabetic nephropathy were 0.72 (95% CI 0.68, 0.75) and 0.69 (95% CI 0.67, 0.72), respectively. The area under the summary receiver operating characteristic curve was 0.75, and the diagnostic odds ratio was 5.67 (95% CI 3.45, 9.34). For proliferative diabetic retinopathy, the pooled sensitivity was 0.25 (95% CI 0.16, 0.35), while the specificity was 0.98 (95% CI 0.92, 1

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Clinical Predictors of Non-diabetic Renal Disease and Role of Renal Biopsy in Diabetic Patients with Renal Involvement: A Single Centre Review

Cited by 79 publications

References 27 publications

The Prevalence and Management of Diabetic Nephropathy in Asia

The Prevalence and Management of Diabetic Nephropathy in Asia

Renal biopsy in patients with diabetes: a pooled meta-analysis of 48 studies

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

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