Insights into the Role of Renal Biopsy in Patients with T2DM: A Literature Review of Global Renal Biopsy Results

Abstract

Introduction Renal biopsy performed in patients with type 2 diabetes mellitus (T2DM) for atypical or suspected diabetic kidney disease (DKD) reveals one of three possibilities: diabetic nephropathy (DN, pathological diagnosis of DKD), nondiabetic kidney disease (NDKD) and DN plus NDKD (mixed form). NDKD (including the mixed form) is increasingly being recognized worldwide. With the emerging concept of DKD and the complexity of routine application of renal biopsy, the identification of “clinical indicators” to differentiate DKD from NDKD has been an area of active research. Methods The PubMed database was searched for relevant articles mainly according to the keyword search method. We reviewed prevalence of the three types of DKD and different pathological lesions of NDKD. We also reviewed the clinical indicators used to identify DKD and NDKD. Results The literature search identified 40 studies (5304 data) worldwide between 1977 and 2019 that looked at global renal biopsy and pathological NDKD lesions. The overall prevalence rate of DN, NDKD and DN plus NDKD is reported to be 41.3, 40.6 and 18.1%, respectively. In Asia, Africa (specifically Morocco and Tunisia) and Europe, the most common isolated NDKD pathological type is membranous nephropathy, representing 24.1, 15.1 and 22.6% of cases, respectively. In contrast, focal segmental glomerulosclerosis is reported to be the primary pathological type in North America (specifically the USA) and Oceania (specifically New Zealand), representing 22% and 63.9% of cases, respectively. Tubulointerstitial disease accounts for a high rate in the mixed group (21.7%), with acute interstitial nephritis being the most prevalent (9.3%), followed by acute tubular necrosis (9.0%). Regarding clinical indicators to differentiate DKD from NDKD, a total of 14 indicators were identified included in 42 studies. Among these, the most commonly studied indicators included diabetic retinopathy, duration of diabetes, proteinuria and hematuria. Regrettably, indicators with high sensitivity and specificity have not yet been identified. Conclusion To date, renal biopsy is still the gold standard to diagnose diabetes complicated with renal disease, especially when T2DM patients present atypical DKD symptoms (e.g. absence of diabetic retinopathy, shorter duration of diabetes, microscopic hematuria, sub-nephrotic range proteinuria, lower glycated hemoglobin, lower fasting blood glucose). We conclude that renal biopsy as early as possible is of great significance to enable personalized treatment to T2DM patients.

New insights into diabetes mellitus and its complications: a narrative review

“…Tong et al have searched identified 40 studies worldwide between 1977 and 2019 that looked at global renal biopsy and pathological nondiabetic kidney disease (NDKD) lesions. The results have shown that overall prevalence rate of DN, NDKD and DN plus NDKD is 41.3, 40.6 and 18.1%, respectively (13). Therefore, it is of great significance to do renal biopsy as early as possible to confirm the diagnosis and to enable personalized treatment especially when T2DM patients present atypical diabetic kidney disease (DKD) symptoms (e.g., absence of diabetic retinopathy, shorter duration of diabetes, microscopic hematuria, subnephrotic range proteinuria, lower glycated hemoglobin, lower fasting blood glucose).…”

Chronic kidney disease in patients with diabetes mellitus

“…Type 2 diabetes patients are often older at the time of diagnosis and kidney disease due to other causes than diabetes is likely to occur. Several studies have verified that kidney disease in type 2 diabetes may be a more compounded entity than what is seen in type 1 diabetes ( 9 ). One study from the United States which examined kidney biopsies in patients with type 2 diabetes and kidney disease found that typical diabetic microvascular disease were present in 37% of the cases, non-diabetic kidney disease in 36% of the cases, such as nephrosclerosis or immunological kidney disease, while mixed forms of diabetic and non-diabetic kidney disease were found in 27% of the cases ( 10 ).…”

“…increased albuminuria, hypertension and slow decrease in estimated GFR). However, other diseases must be suspected when no other microvascular complications of diabetes are present and also in the presence of microscopic haematuria ( 9 ). The pathological classification system developed for chronic kidney disease in type 1 diabetes also includes type 2 diabetes ( 3 ).…”

The Multi-Therapeutic Role of MSCs in Diabetic Nephropathy

“…Diabetic nephropathy (DN) is one of the most common complications of Diabetic Mellitus (DM) (1). Parallel with the rising global prevalence of diabetes, DN often occurs after diabetic retinopathy, another microvascular complication of DM, presenting symptoms after 10 to 15 years of diabetes (2)(3)(4). The characteristics of DN are concluded as persistent proteinuria, reduced total glomerular filtration rate, raised arterial blood pressure, fluid retention, and shrunken kidney size (5)(6)(7).…”