Renal outcomes in patients with type 2 diabetes with or without coexisting non-diabetic renal disease

Chang, Tae Ik; Park, Sun-Hee; Kim, Jwa Kyung; Kim, Seung Jun; Oh, Hyung Jung; Yoo, Dong Eun; Han, Seung Hyeok; Yoo, Tae Hyun; Kang, Shin Wook

doi:10.1016/j.diabres.2011.01.017

Cited by 106 publications

(149 citation statements)

References 36 publications

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“…Our results are an important addition to previously reported data from smaller cohorts on biopsy findings in (1,2), the majority of reports have suggested that a higher degree of proteinuria is found in DN than in NDRD (3,4,8,10,11).…”

Section: Discussionsupporting

confidence: 56%

“…The value of such serologic testing in predicting NDRD has not been reported by others (1)(2)(3)(4)8,10,11). In our cohort, although the finding of any positive serologic test performed at the time of biopsy was not predictive of NDRD, the specific findings of low complement levels (low C3 and/or low C4) and M-spike in either serum or urine, on univariate analyses, were associated with NDRD on biopsy.…”

Section: Discussioncontrasting

confidence: 45%

“…The clinical features that have previously been shown to predict renal involvement by NDRD in the diabetic patient are sudden onset of proteinuria, proteinuria in the absence of retinopathy or neuropathy, short duration of DM, ARF, and hematuria (1,2). Conversely, the factors predicting DN include the presence of retinopathy or neuropathy and longer duration of DM, generally exceeding 10 years (2-4).…”

Section: Introductionmentioning

confidence: 99%

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The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

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Radhakrishnan

et al. 2013

Clinical Journal of the American Society of Nephrology

263

233

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SummaryBackground and objectives Renal biopsies performed in diabetic patients are increasing in number and complexity. This study sought to determine the usefulness of renal biopsy in patients with diabetes and the predictability of diagnosing diabetic nephropathy (DN) versus nondiabetic renal disease (NDRD) from clinical and laboratory data.Design, setting, participants, & measurements To assess modern trends, a retrospective study was performed of clinical-pathologic findings in all patients with diabetes who had a biopsy in 2011. Among 2642 native kidney biopsies, 620 (23.5%) were from patients with diabetes.Results The cohort included 371 men (60.7%) aged a median (interquartile range) 62 years (52-69) with 10-year (5-15) duration of diabetes mellitus (DM). Median serum creatinine was 2.5 mg/dl (1.6-4.4), and 52% of patients had stage 4-5 CKD. On biopsy, 37% of patients had DN alone, 36% had NDRD alone, and 27% had DN plus NDRD. In NDRD alone, FSGS (22%), hypertensive nephrosclerosis (18%), acute tubular necrosis (ATN) (17%), IgA nephropathy (11%), membranous GN (8%), and pauci-immune GN (7%) comprised 80% of diagnoses, compared with ATN (43%), hypertensive nephrosclerosis (19%), FSGS (13%), and IgA nephropathy (7%) for DN plus NDRD. In multivariate analyses, longer duration of DM was associated with a greater likelihood of DN and a lower likelihood of NDRD: each added year of DM reduced the odds of NDRD by 5% (odds ratio, 0.95; 95% confidence interval, 0.91 to 0.98; P=0.004). DM duration $12 years was the best predictor (58% sensitivity, 73% specificity) of DN alone.Conclusions Approximately one-quarter of all renal biopsies are performed in patients with DM. Judicious use of renal biopsy has uncovered NDRD alone or superimposed on DN in the majority of such biopsies. ATN is emerging as an important category of NDRD, which has not been reported previously.

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Section: Discussionsupporting

confidence: 56%

Section: Discussioncontrasting

confidence: 45%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

Sharma

Bomback

Radhakrishnan

et al. 2013

Clinical Journal of the American Society of Nephrology

263

233

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“…According to current guidelines, the presence of >3 RBCs/hpf is considered clinically significant microscopic hematuria26. There have been various criteria, for both scientific research and the clinical diagnoses of hematuria: >2 RBCs/hpf6, >3 RBCs/hpf14, 15, >5 RBCs/hpf27, >10 RBCs/hpf3, and >15 RBCs/hpf. As a result, the incidence of hematuria varied from 4.9 to 39.3%.…”

Section: Discussionmentioning

confidence: 99%

Dysmorphic erythrocytes are superior to hematuria for indicating non‐diabetic renal disease in type 2 diabetics

Dong

Wang

Qiu

et al. 2015

J of Diabetes Invest

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Aims/IntroductionThere are sparse and limited studies on erythrocyte morphology in renal biopsy identifying nephropathic patients among type 2 diabetics. The present study sought to clarify the predictive value of dysmorphic erythrocytes in type 2 diabetics with non‐diabetic renal disease and influences on hematuria.Materials and MethodsWe examined 198 patients with type 2 diabetes who underwent kidney biopsies between 2012 and 2013. Hematuria was defined as >3 or >10 red blood cells per high‐power field (RBCs/hpf) in urine sediment. If >80% of the erythrocytes were dysmorphic, glomerular hematuria was diagnosed. Clinical findings and predictive value of dysmorphic erythrocytes were compared between patients with hematuria (n = 19) and those without (n = 61). The potential risk factors for hematuria among diabetic nephropathy patients were also screened.ResultsThere was a statistically significant difference between the diabetic nephropathy group and the non‐diabetic renal disease group (6.6 vs 16.8%; P = 0.04) when the demarcation point of hematuria was 10 RBCs/hpf. When the definition of hematuria was based on an examination of urinary erythrocyte morphology, a marked difference was seen (3.3 vs 24.8%; P < 0.001). Glomerular hematuria showed high specificity and a positive predictive value (0.97 and 0.94, respectively) in non‐diabetic renal disease. A multivariate analysis showed that nephrotic syndrome was significantly associated with hematuria (odds ratio 3.636; P = 0.034).ConclusionsDysmorphic erythrocytes were superior to hematuria for indicating non‐diabetic renal disease in type 2 diabetics. Nephrotic syndrome was an independent risk factor for hematuria.

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“…This finding is in agreement with results of other studies. 8,9,13,14 Overall, the common NDRD in both groups (II and III) were MN (34%), FGS (20.5%), AIN (20.5%), and IgA nephropathy (10%). These findings are in contrast to reports from Southeast Asia which IgA nephropathy (up to 65%) was the most common NDRD.…”

Section: Discussionmentioning

confidence: 99%

Non-diabetic renal disease with or without diabetic nephropathy in type 2 diabetes: clinical predictors and outcome

et al. 2015

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Background: Renal involvement in type 2 diabetes is mostly due to diabetic nephropathy (DN), but a subset of diabetic patients could present with pure non-diabetic renal disease (NDRD) or NDRD superimposed on DN. We conducted a prospective cohort study to identify the underline renal pathology in type 2 diabetic patients with defined clinical criteria for renal biopsy.Methods: A total of 46 patients (27 female, mean age of 48.9 ± 11.9 years) with type 2 diabetes mellitus (DM) and atypical features of DN with unexpected proteinuria, hematuria, and/or renal impairment were enrolled in this study. Results: Of 46 patients with type 2 diabetes, 16 (34.8%) had DN, 20 (43.5%) had NDRD, and 10 (21.7%) had NDRD superimposed on DN. Membranous nephropathy (34%) was the most common NDRD. Patients with NDRD had a lower frequency of diabetic retinopathy (5%), shorter duration of diabetes, higher range of proteinuria, and better kidney survival. In multiple logistic regression analysis, only lack of diabetic retinopathy was independent predictor of NDRD. Positive and negative predictive value of diabetic retinopathy (DR) for diabetic nephropathy was 94 and 68%, respectively. Conclusion: Kidney biopsy is strongly recommended for patients with type 2 diabetes and atypical renal presentation for DN, particularly in the absence of DR. This approach could lead to diagnosis of NDRD with better renal survival.

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Renal outcomes in patients with type 2 diabetes with or without coexisting non-diabetic renal disease

Cited by 106 publications

References 36 publications

The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

Dysmorphic erythrocytes are superior to hematuria for indicating non‐diabetic renal disease in type 2 diabetics

Non-diabetic renal disease with or without diabetic nephropathy in type 2 diabetes: clinical predictors and outcome

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