Validation of a differential diagnostic model of diabetic nephropathy and non‐diabetic renal diseases and the establishment of a new diagnostic model 糖尿病肾病和非糖尿病性肾脏疾病的鉴别诊断模型的验证及新模型的建立

Liu, Moyan; Chen, Xiangmei; Sun, Xuefeng; Zhou, Jianhui; Zhang, Xueguang; Zhu, Hanyu; Chen, Yizhi; Liu, Shuwen; Wei, Ri-bao; Li, Tang; Cai, Guangyan; Zhang, Li; Bai, Xueyuan

doi:10.1111/1753-0407.12150

Cited by 46 publications

(48 citation statements)

References 25 publications

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“…Indeed, several reports have suggested that hematuria is a sign of DN2, 24. The incidence of hematuria was 32.3–78% in renal biopsy studies of patients with type 2 diabetes mellitus and proteinuria6, 7, 8. More importantly, hematuria had low specificity for the diagnosis of NDRD25.…”

Section: Discussionmentioning

confidence: 98%

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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Section: Discussionmentioning

confidence: 98%

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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“…However, the pooled positive predictive value (PPV) for DN was measured to be only 0.72 in a meta-analysis of its most accurate predictor, DR 9 . A diagnostic model developed at a single center in China which included diabetes duration, systolic blood pressure, HbA1c, hematuria, hemoglobin and diabetic retinopathy as parameters, showed a PPV of 0.89 for DN 11 . These biopsy studies included specially selected patients with DKD, who usually presented with heavy proteinuria and were young 9, 10, 12 .…”

Section: Introductionmentioning

confidence: 99%

Diabetic Retinopathy and Clinical Parameters Favoring the Presence of Diabetic Nephropathy could Predict Renal Outcome in Patients with Diabetic Kidney Disease

Hung

Lin

Hwang

et al. 2017

Sci Rep

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Diabetes duration, diabetic retinopathy (DR), and a diagnostic model have been proposed as clinical parameters favoring the presence of diabetic nephropathy (DN) in biopsied patients with diabetic kidney disease. DN, compared with non-diabetic renal disease, had poorer renal outcomes. We tested whether these clinical parameters favoring DN are associated with poorer renal outcomes in non-biopsied patients. In this study, 1330 patients with type 2 diabetes and chronic kidney disease stages 1–4 were included and divided according to diabetes mellitus (DM) duration >8 years, DR, or a diagnostic model for DN. These clinical parameters favoring DN were found in 62–77% of patients and associated with higher levels of proteinuria. In a Cox survival analysis, DR and the diagnostic model favoring DN were associated with an increased risk for end-stage renal disease with adjusted hazard ratios of 1.69 (95% CI: 1.16–2.45, P = 0.006) and 1.66 (95% CI: 1.05–2.61, P = 0.029), respectively. DR was associated with an increased risk for rapid renal disease progression. DM >8 years was not associated with renal outcome. Propensity score-matched analyses also showed similar results. In conclusion, DR and the diagnostic model favoring DN were associated with poorer renal outcomes.

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“…Although certain clinical manifestations such as shorter duration of diabetes, absence of retinopathy, presence of microscopic hematuria, and active urinary sediment are markers associated with NDRD in type 2 diabetes with clinical renal disease, and the histories of diabetes mellitus, systolic blood pressure, glycated HbA1c, hematuria, diabetic retinopathy, and hemoglobin are independently related to DN, renal biopsy remains indispensable to differentiate between DN and NDRD [43–48]. In this study, we examined the difference between DN and NDRD in urinary glycopatterns; our result showed that the relative abundance of (GlcNAc) 2–4 in urinary glycoprotein could effectively distinguish between DN and NDRD, and ROC curve analysis also indicated that the glycopatterns recognized by STL have the potential to serve as a clinical predictor to distinguish between DN and NDRD.…”

Section: Discussionmentioning

confidence: 99%

Glycopatterns of Urinary Protein as New Potential Diagnosis Indicators for Diabetic Nephropathy

Zhu

Liu

et al. 2017

Journal of Diabetes Research

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Diabetic nephropathy is a major cause of chronic kidney disease and end-stage kidney disease. However, so little is known about alterations of the glycopatterns in urine with the development of diabetic nephropathy. Presently, we interrogated glycopatterns in urine specimens using a lectin microarray. The results showed that expression levels of Siaα2-6Gal/GalNAc recognized by SNA exhibited significantly increased tendency with the development of diabetic nephropathy; moreover, SNA blotting indicated glycoproteins (90 kDa, 70 kDa, and 40 kDa) in urine may contribute to this alteration. Furthermore, the glycopatterns of (GlcNAc)2–4 recognized by STL exhibited difference between diabetic and nondiabetic nephropathy. The results of urinary protein microarray fabricated by another 48 urine specimens also indicated (GlcNAc)2–4 is a potential indictor to differentiate the patients with diabetic nephropathy from nondiabetic nephropathy. Furtherly, STL blotting showed that the 50 kDa glycoproteins were correlated with this alteration. In conclusion, our data provide pivotal information to monitor the development of diabetic nephropathy and distinguish between diabetic nephropathy and nondiabetic renal disease based on precise alterations of glycopatterns in urinary proteins, but further studies are needed in this regard.

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Validation of a differential diagnostic model of diabetic nephropathy and non‐diabetic renal diseases and the establishment of a new diagnostic model 糖尿病肾病和非糖尿病性肾脏疾病的鉴别诊断模型的验证及新模型的建立

Abstract: Changes in people with DN, clinical characteristics have reduced the diagnostic efficacy of the 2003 diagnostic model. The newly established model can provide a better, more current differentiation between DN and NDRD.

Cited by 46 publications

References 25 publications

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

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

Diabetic Retinopathy and Clinical Parameters Favoring the Presence of Diabetic Nephropathy could Predict Renal Outcome in Patients with Diabetic Kidney Disease

Glycopatterns of Urinary Protein as New Potential Diagnosis Indicators for Diabetic Nephropathy

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