Nondiabetic renal disease complicating diabetic nephropathy

Hironaka, Kazue; Makino, Hírofumi; Ikeda, Shuji; Haramoto, Toshinori; Ota, Zensuke

doi:10.1016/0891-6632(91)90051-p

Cited by 24 publications

(24 citation statements)

References 8 publications

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“…All studies included patients with Type 2 diabetes. Type 1 diabetic patients represented a small percentage of the study population in six studies (ranging from 8 to 38% of participants) [12,18,32,38,40,41]. No studies reported data based only on patients with Type 1 diabetes.…”

Section: Study and Participants' Characteristicsmentioning

confidence: 99%

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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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Section: Study and Participants' Characteristicsmentioning

confidence: 99%

“…In five studies [6,7,21,26,41] the reasons for performing RB were not further specified. Main characteristics of the studies and participants are summarized in Tables 1 and 2.…”

Section: Study and Participants' Characteristicsmentioning

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

View full text Add to dashboard Cite

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“…The possibility of nondiabetic nephropathy cannot be excluded, especially when diabetic retinopathy is not present. 48,49 The strengths of this study include a longitudinal design that examines the temporal relationship between exposures and the outcome. In addition, our sample was large, well characterized, elderly, and multiethnic, with an adequate representation of women; we had abundant information with regard to pertinent covariates, including a detailed medication inventory and comprehensive laboratory and anthropometric measurements.…”

Section: Palmas Et Al Ambulatory Pulse Pressure and Albuminuriamentioning

confidence: 99%

Ambulatory Pulse Pressure and Progression of Urinary Albumin Excretion in Older Patients With Type 2 Diabetes Mellitus

et al. 2006

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Abstract-We studied whether ambulatory blood pressure monitoring added to office blood pressure in predicting progression of urine albumin excretion over 2 years of follow-up in a multiethnic cohort of older people with type-2 diabetes mellitus. Participants in the Informatics for Diabetes Education and Telemedicine study underwent a baseline evaluation that included office and 24-hour ambulatory blood pressure measurement and a spot urine measurement of albumin-to-creatinine ratio (ACR). Measurements of albumin-to-creatinine ratio were repeated 1 and 2 years later. In bivariate analyses, ambulatory 24-hour pulse pressure was the blood pressure variable most strongly associated with follow-up ACR. Repeated-measures mixed linear models (nϭ1040) were built adjusting for baseline ACR ratio, clustered randomization, time to follow-up, and multiple covariates. When both were entered into the model, ambulatory 24-hour pulse pressure and office pulse pressure were independently associated with follow-up ACR

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“…[4][5][6][7] While it is widely acceptable that the cause of chronic kidney disease in most type 1 diabetics is usually DN by the time they develop microalbuminuria, [8][9][10][11] the routine presumption that DN is the cause of renal impairment in type 2 diabetes mellitus (T2DM) patients may not be correct given that a substantial minority may have nondiabetic renal disease (NDRD) or mixed lesions. 9,[12][13][14][15] The prevalence of NDRD in T2DM from the literature review of renal biopsy studies varies from 27% to 79%, [16][17][18] depending on the selection criteria, threshold of biopsy, and population studied.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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Background: Type 2 diabetes mellitus (T2DM) is reportedly the leading cause of end-stage renal disease (ESRD) worldwide. However, non-diabetic renal diseases (NDRD) are not uncommon among T2DM patients with renal involvement. Our study aimed to examine the prevalence of NDRD in T2DM and clinical markers for diabetic nephropathy (DN) and NDRD and to determine the role of renal biopsy in T2DM patients and its impact on clinical practice. Methods: We conducted a retrospective analysis of T2DM patients in whom renal biopsies were performed from January 2004 to March 2008 (n = 110). Results: Biopsy results were divided into three groups: group I/pure DN (62.7%), group II/isolated NDRD (18.2%), and group III/mixed lesions (19.1%). The causes of NDRD in decreasing order of frequency were acute interstitial nephritis, glomerulonephritides, hypertensive renal disease, and acute tubular necrosis. Significant clinical markers for DN are presence of diabetic retinopathy and longer duration of diabetes. For NDRD, useful clinical markers include the presence of acute renal failure and microscopic hematuria. In the DN subgroup, Indians had significantly shorter duration of diabetes on biopsy compared with Malays and Chinese. Conclusions: NDRD is prevalent in T2DM patients, and given its potentially treatable nature, renal biopsy should be considered in T2DM patients with nephropathy, especially in those with atypical features.

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Nondiabetic renal disease complicating diabetic nephropathy

Cited by 24 publications

References 8 publications

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

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

Ambulatory Pulse Pressure and Progression of Urinary Albumin Excretion in Older Patients With Type 2 Diabetes Mellitus

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

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