Nondiabetic kidney disease in type 2 diabetic patients: A single center experience

Abstract

Nondiabetic renal disease (NDRD) is seen as a cause of proteinuria and renal failure in type 2 diabetes mellitus (DM). The clinical differences between NDRD and diabetic glomerulosclerosis (DGS) are not clear. This study was done to find the spectrum of NDRD in type 2 DM patients and differences in clinical profile between NDRD and DGS patients. Data of patients with type 2 DM who underwent renal biopsy in this institute from 1990 to 2008 were analyzed retrospectively. Patients were categorized as isolated NDRD, NDRD with DGS, and isolated DGS. A total of 75 patients were included. Mean age was 45 ± 10.2 years, male to female ratio was 3.1 : 1, median duration of DM was 12 months (range, 1 year-15 years), proteinuria was 4.2 ± 3.4 g/day, and serum creatinine was 4.3 ± 3.9 mg/dl. Hypertension was observed in 63 (84%) cases and microscopic hematuria in 24 (32%) cases. Nephrotic syndrome (38.7%) was the commonest clinical presentation. Forty-eight (64%) cases had NDRD and 27 (36%) had DGS. The commonest NDRD was minimal change disease (12.5%). Three (6.3%) patients had lupus nephritis. Tubulointerstitial nephritis has been observed in 10.4% patients. No significant differences between NDRD and DGS patients were found except hypertension which was significantly high in the DGS group. Acute kidney injury and nephritic syndrome were not observed in the DGS group. In conclusion, the incidence of biopsy-proven NDRD in type 2 DM in this study was high. Kidney biopsy aided in the detection of NDRD in clinically suspected patients.

Spectrum of biopsy-proven renal diseases in patients with type 2 diabetes mellitus. A single center study

“…Similarly to our results, the most common lesion in the US was focal and segmental glomerular sclerosis [31]. In other studies IgA nephropathy and minimal change disease were found to be the commonest NDRD [32,33]. It must be taken into consideration that the incidence and type of renal involvement depend on biopsy criteria and geographical distribution.…”

Predicting non-diabetic renal disease in type 2 diabetic adults: The value of glycated hemoglobin

“…This study also shows that those with biopsy-proven NDRD have a better composite outcome of end stage renal disease and death. Our finding of high prevalence of NDRD in T2D is consistent with observations made by others (Chong et al, 2012;Das et al, 2012;Harada et al, 2013;Kleinknecht et al, 1992;Lee et al, 1999;Mazzucco et al, 2002;Olsen & Mogensen, 1996;Richards et al, 1992;Soni et al, 2006;Yaqub et al, 2012). These studies showed a variable prevalence of NDRD of 18-78%.…”

“…Estimated glomerular filtration rate (eGFR) declines prior to more severe macroalbuminuria in type 2 diabetes (T2D); hence a combination of eGFR and albuminuria can be used to stage and monitor patients (American Diabetes Association, 2013; Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group, 2013). While diabetes is the major cause of renal disease in patients with diabetes, in about a third of patients, renal dysfunction is due to other causes (non-diabetic renal disease; NDRD) (Chong, Keng, Tan, et al, 2012;Das, Dakshinamurty, Prayaga, & Uppin, 2012;Harada, Akai, Sumida, et al, 2013;Kleinknecht, Bennis, & Altman, 1992;Lee, Chung, & Choi, 1999;Mazzucco, Bertani, Fortunato, et al, 2002;Olsen & Mogensen, 1996;Richards et al, 1992;Soni, Gowrishankar, Kishan, & Raman, 2006;Yaqub, Kashif, & Hussain, 2012). In the NDRD group, the treatment of renal disease may require a different strategy.…”

Spectrum of glomerular diseases - clinico-pathologic observations from a state run tertiary care centre

“…IgA nephropathy (15.6%) and membranous glomerulonephritis (13.3%). 23 The commonest NDRD were MCD (12.5%), tubuloin terstitial nephritis (10.4%) and LN (6.3%) in a study conducted by Das et al 24 LN was the second commonest SGD in the study (7.03%). As reported in other studies, LN is the only GD shown to have female predominance.…”