Kidney Biopsy in Type 2 Diabetes: A Multicenter Cross-Sectional Study

Abstract

<b><i>Introduction:</i></b> Kidney biopsies (KBs) are performed in patients with type 2 diabetes (T2D) to diagnose non-diabetic or hypertensive kidney disease (NDHKD) potentially requiring specific management compared to diabetic and or hypertensive nephropathy (absence of NDHKD). Indications for KB are based on the presence of atypical features compared to the typical course of diabetic nephropathy. In this study, we assessed the association of different patterns of atypical features, or KB indications, with NDHKD. <b><i>Methods:</i></b> Native KBs performed in patients with T2D were analyzed. Data were collected from the patients’ records. KB indications were determined according to the presence of different atypical features considered sequentially: (1) presence of any feature suggesting NDHKD which is not among the following ones, (2) recent onset of nephrotic syndrome, (3) low or rapidly declining estimated glomerular filtration rate (eGFR), (4) rapid increase in proteinuria, (5) short duration of diabetes, (6) presence of hematuria, or (7) normal retinal examination. <b><i>Results:</i></b> Among the 463 KBs analyzed, NDHKD was diagnosed in 40% of the total population and 54, 40, 24, and 7% of the KBs performed for indications 1–4 respectively. Conversely, no patient who underwent KB for indications 5–7 displayed NDHKD. Logistic regression analyses identified eGFR<sub>CKD-EPI</sub> >15 mL/min/1.73 m<sup>2</sup>, urinary protein-to-Cr ratio <0.3 g/mmol, hematuria, HbA1c <7%, and diabetes duration <5 years as predictors of NDHKD, independently from the indication group. <b><i>Conclusion:</i></b> NDHKD is frequent in T2D. Despite the association of hematuria with NDHKD, our results suggest that presence of hematuria and absence of DR are insufficient to indicate KB in the absence of concurrent atypical features. Conversely, rapid progression of proteinuria and rapid deterioration of eGFR are major signals of NDHKD.

The Diagnostic Performance of a Clinical Diagnosis of Diabetic Kidney Disease

“…In six studies published since the that systematic review [15][16][17][18][19][20], the most common shared predictors were the presence/absence of diabetic retinopathy [15][16][17]19,20], the duration of diabetes [16][17][18], and the presence of haematuria [18,20]. A shorter duration of DM (<5 years) predicted NDKD [17,18], whilst longer duration predicted DKD [16].…”

Glomerular crescents are associated with the risk of type 2 diabetic kidney disease progression: a retrospective cohort study

“…4 Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea. 5 Division of Nephrology, Seoul National University Boramae Medical Center, Seoul, Korea. 6 Department of Internal Medicine, National Health Insurance Service Medical Center Ilsan Hospital, Gyeonggi-Do, Korea.…”

“…The diagnosis of DKD is primarily based on clinical features. In certain cases, a kidney biopsy may be required to confirm the diagnosis, because there is a possibility of kidney disease other than DKD [5][6][7]. The Renal Pathology Society (RPS) classification, introduced in 2010, provides a histological classification of DKD [8].…”

Characterization of Diabetic Kidney Disease in 235 Patients: Clinical and Pathological Insights with or without Concurrent Non-Diabetic Kidney Disease

“…Diabetic kidney involvement primarily manifests as diabetic kidney disease (DKD), a leading cause of end-stage kidney disease (ESKD) [1,2]. However, some diabetic patients may solely present with diabetes mellitus or non-diabetic kidney disease (NDKD), or DKD combined with NDRD [3,4]. This study statistically analyzed patients with DKD and DKD + NDKD, investigating their pathological and clinical characteristics, and identifying the independent factors associated with DKD + NDKD to aid clinical differentiation.…”