Clinical Predictors of Nondiabetic Kidney Disease in Patients with Diabetes: A Single-Center Study

Abstract

Background. Although diabetic kidney disease (DKD) could affect up to one-third of patients with diabetes mellitus (DM), these patients can develop kidney diseases different from DKD, or these conditions can superimpose on DKD. Several potential predictors of nondiabetic kidney disease (NDKD) have been proposed, but there are no definitive indications available for kidney biopsy in diabetic patients. Methods. We designed a single-center, cross-sectional, and retrospective cohort study to identify clinical and laboratory factors associated with a diagnosis of NDKD after native kidney biopsy in diabetic patients and to investigate differences in time to end-stage kidney disease (ESKD) in patients with a diagnosis of DKD and NDKD. Results. Of 142 patients included in our analysis, 89 (62.68%) had a histopathological diagnosis of NDKD or mixed NDKD + DKD. Patients in the NDKD group had significantly lower HbA1C, lower prevalence of diabetic retinopathy (DR), and less severe proteinuria, and there was a lower proportion of patients with nephrotic syndrome; the DKD group had significantly lower proportion of patients with hematological conditions. In the multivariate binary logistic regression, only absence of DR and presence of a hematological condition significantly predicted NDKD after adjustment for age and sex. Time to ESKD was significantly higher in patients with NDKD or mixed forms than in those with DKD. Conclusions. After a careful selection, more than half of kidney biopsies performed in diabetic patients can identify NDKD (alone or with concomitant DKD). Absence of DR and coexistence of a hematological condition (especially MGUS) were strong predictors of NDKD in our cohort.

Bacterial infection‐related glomerulonephritis in patients with diabetes

“…To the best of our knowledge, no previous study has addressed this issue in spite of diabetes being the most common predisposing factor, especially in developed countries [10%–44% vs. 3%–21% (developing countries)] 3,9–16 . IRGN remains as one of the most common causes of non‐diabetic kidney disease in developing countries [8%–21% (developing countries) vs. 0%–4% (developed countries)] 17–26 (Table S7). In addition, in most IRGN cohorts underlying diabetes is a risk factor for kidney failure 3,27,28 …”

When to Suspect Non-diabetic Kidney Disease in a Diabetic Patient?

“…Diagnosis of NDKD has got both therapeutic as well as prognostic implications. It leads to a significant change in therapy in almost one-third of biopsied patients [ 10 , 11 ]. Kidney failure and mortality rates are lower in diabetic patients with an underlying NDKD [ 8 ].…”

“…(1) Absence of microvascular complications of diabetes [2,[4][5][6][7][8]11] Proteinuria (>1 g) or renal dysfunction without diabetic retinopathy in patients with type 1 DM (2) Short duration of diabetes [4,6,7,10] Proteinuria (>1 g) or renal dysfunction, which occurs within five years of onset of diabetes, especially in patients with type 1 DM (3) Absence of hypertension [3,7] Proteinuria (>1 g) or renal dysfunction without hypertension (4) Nephrotic range proteinuria [5] Sudden onset of NRP NRP with marked hypoalbuminemia NRP with elevated serum anti PLA2R antibody titers (5) Renal dysfunction [4] Decline in eGFR by >10ml/min/1.73 m²/year Renal dysfunction without proteinuria (suspicion of renal artery stenosis) (6) Glycemic control [2] Progression of proteinuria or rapid decline in eGFR despite aggressive glycemic control (7) Nephritic syndrome [5,[8][9][10] Glomerular hematuria, acanthocytes, and/or red blood cell casts…”

“…Positive serological markers like ANA or ANCA Persistent renal dysfunction despite eradication of infection source (8) Suspicion of monoclonal gammopathy [10,11] Discrepancy between urine dipstick and 24-hour urine protein estimation Detectable circulating monoclonal immunoglobulin by serum protein electrophoresis, immunofixation electrophoresis, or serum free light chain assay (9) Atypical nodular glomerulosclerosis on kidney biopsy [1] Nodules are uniformly distributed within all glomeruli PAS positive, silver negative, and Congo red negative (MIDD) PAS positive, silver negative, and Congo red positive (amyloidosis)…”

“…Diabetic kidney disease (DKD) occurs in 30-40% of diabetic patients of more than 10 years duration [1]. However, 45-80% of diabetics with kidney involvement undergoing kidney biopsy are diagnosed to have non-diabetic kidney disease (NDKD) [2][3][4][5][6][7][8][9][10][11]. There are certain proven clinical predictors of NDKD, which, when present in appropriate clinical settings, would warrant a kidney biopsy.…”