The impact of coexisting diabetes mellitus on clinical outcomes in patients with idiopathic membranous nephropathy: a retrospective observational study

Abstract

Background: Idiopathic membranous nephropathy (IMN) is frequently coexisted with diabetes mellitus (DM). Few researches investigate clinical outcomes in IMN patients coexisting diabetes mellitus (DM), including remission rates, renal survival and complications. Concurrent DM also pose therapeutic challenges to IMN patients due to the influence of glucocorticoids and immunosuppressant on metabolic disorders. We performed this study to investigate the impact of DM on clinical outcomes in IMN and the influence of therapeutic regime on metabolic parameters in diabetic IMN patients. Methods: Two hundred and six adult hospitalized patients diagnosed with biopsy-proven IMN were retrospectively studied, including 42 patients coexisted with DM. Clinical outcomes including remission rates, renal outcome and complications were compared between groups. Impact of cyclophosphamide and ciclosporin on metabolism and complications were analyzed in IMN patients coexisting DM. Results: IMN patients coexisted with DM were presented with advanced age, lower level of eGFR and hemoglobin. Patients coexisted with DM experienced worse renal function deterioration and higher incidence of infection. COX regression analysis showed that DM was an independent risk factor for renal function deterioration in IMN patients. There was no significant difference in remission rates and incidence of venous thromboembolism between two groups. Further exploration on the impact of therapeutic regimens on complications and metabolism showed that cyclophosphamide and ciclosporin had no significant difference in incidence of complications including infection and venous thromboembolism, and posed comparable influences on blood glucose, uric acid and blood lipids in IMN patients coexisted with DM.

Urine albumin-to-creatinine ratio diurnal variation rate predicts outcomes in idiopathic membranous nephropathy

“…However, the impact of DM on IMN outcomes is still elusive. Xie et al [ 21 ] compared the remission rate of patients with or without DM and concluded that even though patients with concomitant DM experienced worse renal function deterioration, no significant differences were found in remission rates between the two groups. However, another study also conducted in China, but with a larger sample size, demonstrated that concomitant DM at IMN presentation is an independent risk factor for failure to achieve CR [ 22 ].…”

CureGN-Diabetes Study: Rationale, Design, and Methods of a Prospective Observational Study of Glomerular Disease Patients with Diabetes

“…Patients with concurrent DGS and MN on biopsy have been shown to have reduced eGFR (48.0 vs. 70.8 mL/min/1.73 m 2 ) and greater tubulointerstitial fibrosis (25.3% vs. 6.3%) compared to those with MN alone, though the same has not been seen with FSGS [ 36 ]. A study of MN from China found that both eGFR and proteinuria at the time of kidney biopsy were worse in the setting of comorbid diabetes, regardless of the presence of DGS on pathology [ 37 ].…”

“…The presence of concurrent diabetes or histologic DGS has been associated with a higher rate of progression to ESKD in FSGS and MN [ 36 , 37 ]. These data align with a 2011 retrospective study by Chang et al [ 38 ] showing significantly worse cumulative renal survival in patients with DGS alone versus either NDKD alone or concomitant DGS and NDKD, suggesting potential prognostic value of biopsy in cases with clinical suspicion for NDKD.…”

Isoliquiritigenin ameliorates advanced glycation end‐products toxicity on renal proximal tubular epithelial cells

“…About 20-40% of type 2 diabetes patients with microalbuminuria show overt nephropathy and about 20% will develop end-stage renal disease. [1][2][3] Diabetic nephropathy (DN) characterized by diabetic tubular damages and glomerular lesions lead to chronic kidney disease and end-stage renal failure. The risk factors in diabetes contributing to renal damages include free fatty acids, high glucose and advanced glycation end-products (AGEs).…”

“…Diabetes affects various internal organs causing neuropathy, retinopathy, myopathy, nephropathy etc. About 20–40% of type 2 diabetes patients with microalbuminuria show overt nephropathy and about 20% will develop end‐stage renal disease 1–3 . Diabetic nephropathy (DN) characterized by diabetic tubular damages and glomerular lesions lead to chronic kidney disease and end‐stage renal failure.…”