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Heterogeneity in Kidney Histology and Its Clinical Indicators in Type 2 Diabetes Mellitus: A Retrospective Study. J Clin Med 2023; 12:jcm12051778. [PMID: 36902564 PMCID: PMC10003520 DOI: 10.3390/jcm12051778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/26/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
The heterogeneous spectrum of kidney disease in diabetes ranges from albuminuric or non-albuminuric diabetic kidney disease to non-diabetic kidney diseases. Presumptive clinical diagnosis of diabetic kidney disease may lead to an erroneous diagnosis. MATERIAL AND METHOD We analyzed the clinical profile and kidney biopsy of a total of 66 type 2 diabetes patients. Based on kidney histology, they were divided into-Class I (Diabetic Nephropathy), Class II (Non-diabetic kidney disease), and Class III (Mixed lesion). Demographic data, clinical presentation, and laboratory values were collected and analyzed. This study tried to examine the heterogeneity in kidney disease, its clinical indicator, and the role of kidney biopsy in the diagnosis of kidney disease in diabetes. RESULTS Class I consisted of 36(54.5%), class II 17(25.8%), and class III 13(19.7%) patients. The commonest clinical presentation was nephrotic syndrome 33(50%) followed by chronic kidney disease 16(24.4%) and asymptomatic urinary abnormality 8(12.1%). Diabetic retinopathy (DR) was present in 27(41%) cases. DR was significantly higher in the class I patients (p < 0.05). Specificity and positive predictive values of DR for DN were 0.83 and 0.81, respectively (sensitivity 0.61; negative predictive values 0.64). The Association of the duration of diabetes and the level of proteinuria with DN was statistically not significant (p > 0.05). Idiopathic MN (6) and Amyloidosis (2) were the most common isolated NDKD; whereas diffuse proliferative glomerulonephritis (DPGN) (7) was the commonest NDKD in mixed disease. Another common form of NDKD in mixed disease was Thrombotic Microangiopathy (2) and IgA nephropathy (2). NDKD was observed in 5(18.5%) cases in presence of DR. We noted biopsy-proven DN even in 14(35.9%) cases without DR, in 4(50%) cases with microalbuminuria and 14(38.9%) cases with a short duration of diabetes. CONCLUSION Almost half (45%) of cases with atypical presentation have non-diabetic kidney disease (NDKD), though even among these cases with atypical presentation diabetic nephropathy (either alone or in mixed form) is commonly seen in 74.2% of cases. DN has been seen in a subset of cases without DR, with microalbuminuria, and with a short duration of diabetes. Clinical indicators were insensitive in distinguishing DN Vs NDKD. Hence, a kidney biopsy may be a potential tool for the accurate diagnosis of kidney disease.
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Prasad N, Veeranki V, Bhadauria D, Kushwaha R, Meyyappan J, Kaul A, Patel M, Behera M, Yachha M, Agrawal V, Jain M. Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Changing Spectrum with Therapeutic Ascendancy. J Clin Med 2023; 12:1705. [PMID: 36836240 PMCID: PMC9964578 DOI: 10.3390/jcm12041705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Owing to changing epidemiology and therapeutic practices, a change in the spectrum of renal involvement in Type-2 diabetes mellitus (T2DM) has also been noted. The treatment of non-diabetic kidney disease (NDKD) differs from diabetic kidney disease (DKD) and the reversibility of NDKD in many cases to normal, prompts biopsy for rapid and accurate diagnosis. Data are scarce on kidney biopsy findings in T2DM. STUDY DESIGN & SETTING In this observational study, we prospectively collected the data of kidney biopsies of patients aged ≥ 18 years with T2DM admitted between 1 August 2005 and 31 July 2022. The clinical, demographic and histopathological data were evaluated. The spectrum of kidney involvement in the form of DKD and/or NDKD was studied. The impact of these findings with the use of drugs retarding disease progression was also analyzed. RESULTS A total of 5485 biopsies were performed during the study period and of these 538 patients had T2DM. The mean age of the study population was 56.9 ± 11.5 years and 81% were males. The mean duration of DM was 6.4 ± 6.1 years. Diabetic retinopathy (DR) was noted in 29.7%. The most common indication for biopsy was an acute rise in creatinine (147, 27.3%). Amongst the 538 diabetic patients who underwent biopsy, histological features only of DKD were noted in 166 patients (33%), NDKD alone in 262 (49%) and NDKD with DKD lesions in 110 (20%). On multivariate analysis, duration of DM less than 5 years, absence of CAD, absence of DR, oliguria at presentation, an acute rise in creatinine and low C3 were associated with NDKD. CONCLUSIONS The prevalence of NDKD among diabetics and ATIN in particular might be on an increasing trend in the current era of changing T2DM epidemiological patterns. The use of anti-pro-teinuric agents was associated with lesser degrees of histopathological chronicity in T2DM.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Vamsidhar Veeranki
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Dharmendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ravi Kushwaha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Jeyakumar Meyyappan
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Anupama Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Manas Patel
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Manas Behera
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Monika Yachha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Vinita Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Manoj Jain
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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John EE, Roy S, Eapen JJ, Alam R, Varughese S. When to Suspect Non-diabetic Kidney Disease in a Diabetic Patient? Cureus 2022; 14:e28091. [PMID: 36158327 PMCID: PMC9484782 DOI: 10.7759/cureus.28091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/29/2022] Open
Abstract
The diagnosis of non-diabetic kidney disease (NDKD) in a diabetic patient has significant therapeutic and prognostic implications. There are certain proven clinical predictors of NDKD, which, when present in an appropriate clinical setting, would warrant a kidney biopsy. Herein, we describe four cases of NDKD diagnosed in rather unusual clinical settings, which add to the list of clinical predictors of NDKD. The first case was a “parainfectious glomerulonephritis” diagnosed in a 50-year-old diabetic woman who presented with persistent renal dysfunction despite successful treatment of urinary tract infection. The second case was “membranous nephropathy” diagnosed in a 43-year-old man with long-standing type 1 diabetes, which was associated with other microvascular complications. In this case, the only predictor was disproportionately low serum albumin. The third case was “amyloid light chain (AL) amyloidosis” diagnosed in an elderly diabetic who presented with progressive anasarca over six months. In this case, the only clinical predictor was a disassociation observed between urine dipstick and 24-hour protein estimation. In the fourth case, an elderly diabetic woman without underlying diabetic retinopathy presented with sudden onset nephrotic syndrome. A kidney biopsy was suggestive of diffuse nodular glomerulosclerosis. Immunofluorescence and electron microscopic evaluation were diagnostic of “gamma heavy chain deposition disease.” In all four cases, diagnosis of NDKD led to major therapeutic changes and attainment of renal remission. We have extensively reviewed all major biopsy cohorts of NDKD and have formulated an approach to the diagnosis of NDKD.
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Zhang W, Liu X, Dong Z, Wang Q, Pei Z, Chen Y, Zheng Y, Wang Y, Chen P, Feng Z, Sun X, Cai G, Chen X. New Diagnostic Model for the Differentiation of Diabetic Nephropathy From Non-Diabetic Nephropathy in Chinese Patients. Front Endocrinol (Lausanne) 2022; 13:913021. [PMID: 35846333 PMCID: PMC9279696 DOI: 10.3389/fendo.2022.913021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The disease pathology for diabetes mellitus patients with chronic kidney disease (CKD) may be diabetic nephropathy (DN), non-diabetic renal disease (NDRD), or DN combined with NDRD. Considering that the prognosis and treatment of DN and NDRD differ, their differential diagnosis is of significance. Renal pathological biopsy is the gold standard for diagnosing DN and NDRD. However, it is invasive and cannot be implemented in many patients due to contraindications. This article constructed a new noninvasive evaluation model for differentiating DN and NDRD. METHODS We retrospectively screened 1,030 patients with type 2 diabetes who has undergone kidney biopsy from January 2005 to March 2017 in a single center. Variables were ranked according to importance, and the machine learning methods (random forest, RF, and support vector machine, SVM) were then used to construct the model. The final model was validated with an external group (338 patients, April 2017-April 2019). RESULTS In total, 929 patients were assigned. Ten variables were selected for model development. The areas under the receiver operating characteristic curves (AUCROCs) for the RF and SVM methods were 0.953 and 0.947, respectively. Additionally, 329 patients were analyzed for external validation. The AUCROCs for the external validation of the RF and SVM methods were 0.920 and 0.911, respectively. CONCLUSION We successfully constructed a predictive model for DN and NDRD using machine learning methods, which were better than our regression methods. CLINICAL TRIAL REGISTRATION ClinicalTrial.gov, NCT03865914.
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Affiliation(s)
- WeiGuang Zhang
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - XiaoMin Liu
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - ZheYi Dong
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Qian Wang
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - ZhiYong Pei
- Beijing Computing Center, Beike Industry, Yongfeng Industrial Base, Beijing, China
| | - YiZhi Chen
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
- Department of Nephrology, Hainan Hospital of Chinese PLA General Hospital, the Hainan Academician Team Innovation Center, Sanya, China
| | - Ying Zheng
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Yong Wang
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Pu Chen
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Zhe Feng
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - XueFeng Sun
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
- *Correspondence: XiangMei Chen, ; Guangyan Cai,
| | - XiangMei Chen
- Department of Nephrology, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
- *Correspondence: XiangMei Chen, ; Guangyan Cai,
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Zhou DM, Wei J, Zhang TT, Shen FJ, Yang JK. Establishment and Validation of a Nomogram Model for Prediction of Diabetic Nephropathy in Type 2 Diabetic Patients with Proteinuria. Diabetes Metab Syndr Obes 2022; 15:1101-1110. [PMID: 35431563 PMCID: PMC9005335 DOI: 10.2147/dmso.s357357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To establish and validate the nomogram model for predicting diabetic nephropathy (DN) in type 2 diabetes mellitus (T2DM) patients with proteinuria. METHODS A total of 102 patients with T2DM and proteinuria who underwent renal biopsy were included in this study. According to pathological classification of the kidney, the patients were divided into two groups, namely, a DN group (52 cases) and a non-diabetic renal disease (NDRD) group (50 cases). The clinical data were collected, and the factors associated with diabetic nephropathy (DN) were analyzed with multivariate logistic regression. A nomogram model for predicting DN risk was constructed by using R4.1 software. Receiver operator characteristic (ROC) curves were generated, and the K-fold cross-validation method was used for validation. A consistency test was performed by generating the correction curve. RESULTS Systolic blood pressure (SBP), diabetic retinopathy (DR), hemoglobin (Hb), fasting plasma glucose (FPG) and triglyceride/cystatin C (TG/Cys-C) ratio were independent factors for DN in T2DM patients with proteinuria (P<0.05). The nomogram model had good prediction efficiency. If the total score of the nomogram exceeds 200, the probability of DN is as high as 95%. The area under the ROC curve was 0.9412 (95% confidence interval (CI) = 0.8981-0.9842). The 10-fold cross-validation showed that the prediction accuracy of the model was 0.8427. The Hosmer-Lemeshow (H-L) test showed that there was no significant difference between the predicted value and the actual observed value (X 2 = 6.725, P = 0.567). The calibration curve showed that the fitting degree of the DN nomogram prediction model was good. CONCLUSION The nomogram model constructed in the present study improves the diagnostic efficiency of DN in T2DM patients with proteinuria, and it has a high clinical value.
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Affiliation(s)
- Dong-mei Zhou
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of China
- Department of Endocrinology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, People’s Republic of China
| | - Jing Wei
- Department of Endocrinology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, People’s Republic of China
| | - Ting-ting Zhang
- Department of Endocrinology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, People’s Republic of China
| | - Feng-jie Shen
- Department of Endocrinology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, People’s Republic of China
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of China
- Correspondence: Jin-Kui Yang, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of China, Email
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Lyngdoh BS, Baishya P, Mishra J, Marbaniang E, Dey B. IgA nephropathy superimposed on diabetic nephropathy: A case report with review of literature in eight Indian studies. J Family Med Prim Care 2021; 10:2419-2422. [PMID: 34322449 PMCID: PMC8284210 DOI: 10.4103/jfmpc.jfmpc_1962_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/02/2020] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Diabetes mellitus is one of the foremost diseases in the modern era and diabetic nephropathy contributes to a major percentage of end-stage kidney disease. Although diabetic nephropathy is difficult to revert back, detection of nondiabetic renal disease (NDRD) is important to detect as most of them are treatable. We describe a case of a 62-year-old female with long-standing diabetes mellitus presenting with massive proteinuria and clinical features of nephrotic syndrome. The kidney biopsy showed class III diabetic nephropathy along with focal proliferative glomerulonephritis with crescent formations. The immunofluorescence study showed strong mesangial IgA deposition with the predominance of lambda stain. This confirmed the diagnosis of diabetic nephropathy with superimposed IgA nephropathy. We reviewed eight Indian studies herewith to demonstrate NDRD spectrum in the Indian diabetic scenario.
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Affiliation(s)
- Bifica Sofia Lyngdoh
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India
| | - Pakesh Baishya
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India
| | - Jaya Mishra
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India
| | - Evarisalin Marbaniang
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India
| | - Biswajit Dey
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India
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Kaya B, Paydas S, Kuzu T, Basak Tanburoglu D, Balal M, Eren Erdogan K, Gonlusen G. Primary glomerulonephritis in diabetic patients. Int J Clin Pract 2021; 75:e13713. [PMID: 32955768 DOI: 10.1111/ijcp.13713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Primary glomerulonephritis (PGN) has a significant part in non-diabetic kidney disease (NDKD) in diabetes mellitus (DM) patients. In our study, we compared the clinical, demographic and laboratory features of patients with biopsy-proven diabetic nephropathy (DN) and PGN with type 2 DM. METHODS In our retrospective study, type 2 DM patients who underwent kidney biopsy between 2011 and 2019 were included. Demographic, clinical and laboratory characteristics of DN and PGN patients were compared. RESULTS Seventy patients with a mean age of 55.7 ± 9.4 and 43 (61.4%) males were included. About 38 (54.3%) of the patients had DN and 32 (45.7%) had PGN. In the PGN, membranous GN (20, 62.5%) was most common. In DN patients, diabetes duration was longer; complications such as retinopathy, neuropathy, hypertension, coronary artery disease, heart failure were more frequent. At the time of renal biopsy, blood sugar, HbA1C, blood pressure, serum albumin and proteinuria values were similar in two groups. The pathological damage findings of kidney biopsy in DN patients were more severe. In the first year after kidney biopsy decrease in eGFR was higher in DN patients, whereas eGFR did not change in PGN patients. CONCLUSION In a diabetic patient, fasting blood sugar, hbA1C, serum albumin and proteinuria did not differ in the differential diagnosis of DN and PGN, whereas complications of DM (retinopathy, neuropathy, hypertension, coronary artery disease) were more characteristic in differentiation. Detection of PGN in a diabetic patient is crucial for the success of the treatment, according to DN.
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Affiliation(s)
- Bulent Kaya
- Department of Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Saime Paydas
- Department of Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Tolga Kuzu
- Department of Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | | | - Mustafa Balal
- Department of Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | | | - Gulfiliz Gonlusen
- Department of Pathology, Cukurova University Faculty of Medicine, Adana, Turkey
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Li H, Shen Y, Yu Z, Huang Y, He T, Xiao T, Li Y, Xiong J, Zhao J. Potential Role of the Renal Arterial Resistance Index in the Differential Diagnosis of Diabetic Kidney Disease. Front Endocrinol (Lausanne) 2021; 12:731187. [PMID: 35095752 PMCID: PMC8796316 DOI: 10.3389/fendo.2021.731187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 12/15/2021] [Indexed: 12/26/2022] Open
Abstract
AIMS To investigate the potential role of renal arterial resistance index (RI) in the differential diagnosis between diabetic kidney disease (DKD) and non-diabetic kidney disease (NDKD) and establish a better-quantified differential diagnostic model. MATERIALS AND METHODS We consecutively reviewed 469 type 2 diabetes patients who underwent renal biopsy in our center. According to the renal biopsy results, eligible patients were classified into the DKD group and the NDKD group. The diagnostic significance of RI was evaluated by receiver operating characteristic (ROC) curve analysis. Logistic regression analysis was used to search for independent risk factors associated with DKD. Then a novel diagnostic model was established using multivariate logistic regression analysis. RESULTS A total of 332 DKD and 137 NDKD patients were enrolled for analysis. RI was significantly higher in the DKD group compared with those in the NDKD group (0.70 vs. 0.63, p< 0.001). The optimum cutoff value of RI for predicting DKD was 0.66 with sensitivity (69.2%) and specificity (80.9%). Diabetic retinopathy, diabetes duration ≥ 60 months, HbA1c ≥ 7.0(%), RI ≥ 0.66, and body mass index showed statistical significance in the multivariate logistic regression analysis. Then, we constructed a new diagnostic model based on these results. And the validation tests indicated that the new model had good sensitivity (81.5%) and specificity (78.6%). CONCLUSIONS RI has a potential role in discriminating DKD from NDKD. The RI-based predicting model can be helpful for differential diagnosis of DKD and NDKD.
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Chandragiri S, Raju SB, Mandarapu SB, Goli R, Nimmagadda S, Uppin M. A Clinicopathological Study of 267 Patients with Diabetic Kidney Disease Based on the Renal Pathology Society - 2010 Classification System. Indian J Nephrol 2020; 30:104-109. [PMID: 32269434 PMCID: PMC7132854 DOI: 10.4103/ijn.ijn_424_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/24/2018] [Accepted: 01/21/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction: Renal biopsy is primarily indicated in patients with diabetes mellitus (DM) with proteinuria, to diagnose non-diabetic renal disease (NDRD). However, Renal Pathology Society classification (RPSc) – 2010 has classified diabetic nephropathy (DN) into four classes of glomerular lesions with a separate scoring for tubulointerstitial and vascular lesions. Paucity of data from Indian subcontinent prompted us to plan this study to classify DN on biopsy as per the RPSc and correlate the clinical profile with histology. Materials and Methods: Patients with DM who underwent renal biopsy for various indications (between Aug 2013 and Nov 2015) were included in the study. DN on histology was classified according to RPSc. Histopathology lesions of DN were correlated with clinical and biochemical profiles. Results: Of the 267 patients studied, 252 (94.3%) were type 2 DM. NDRD alone was seen in 65 (24.34%), DN in 161 (60.3%), and NDRD with DN in 41 (15.3%). The most common indications for biopsy were rapidly progressive renal failure (76.7%) and nephrotic syndrome (16.4%). The most common glomerular class was class IV (43.5%), followed class III (41%), class II (13.3%), and class I (1.9%). The most common NDRD seen was acute interstitial nephritis (AIN) in 20.2% and is frequently associated with class III. Tubulointerstitial chronicity and not the arteriolar chronicity, was correlated with low estimated glomerular filtration rate (eGFR). Conclusions: Most patients with DN subjected to renal biopsy were in class IV, and AIN was the most common NDRD. Only tubulointerstitial chronicity correlated with low eGFR.
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Affiliation(s)
- Susmitha Chandragiri
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sree Bhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Surendra Babu Mandarapu
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rajesh Goli
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sridhar Nimmagadda
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Megha Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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García-Martín F, González Monte E, Hernández Martínez E, Bada Boch T, Bustamante Jiménez NE, Praga Terente M. When to perform renal biopsy in patients with type2 diabetes mellitus? Predictive model of non-diabetic renal disease. Nefrologia 2019; 40:180-189. [PMID: 31761446 DOI: 10.1016/j.nefro.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/20/2019] [Accepted: 07/16/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Diabetic nephropathy (DN) is one of the most frequent complications in patients with diabetes mellitus (DM) and its diagnosis is usually established on clinical grounds. However, kidney involvement in some diabetic patients can be due to other causes, and renal biopsy might be needed to exclude them. The aim of our study was to establish the clinical and analytical data that predict DN and no-diabetic renal disease (NDRD), and to develop a predictive model (score) to confirm or dismiss DN. MATERIAL AND METHODS We conducted a transversal, observational and retrospective study, including renal biopsies performed in type2 DM patients, between 2000 and 2018. RESULTS Two hundred seven DM patients were included in our study. The mean age was 64.5±10.6 years and 74% were male. DN was found in 126 (61%) of the biopsies and NDRD in 81 (39%). Diabetic retinopathy was presented in 58% of DN patients, but only in 6% of NDRD patients (P<.001). Patients with NDRD were diagnosed of primary glomerulopathies (52%), nephroangiosclerosis (16%), inmunoallergic interstitial nephritis (15%) and vasculitis (8.5%). In the multivariate analysis, retinopathy (OR26.7; 95%CI: 6.8-104.5), chronic ischaemia of lower limbs (OR4,37; 95%CI: 1.33-14.3), insulin therapy (OR3.05; 95%CI: 1.13-8.25), time course of DM ≥10years (OR2.71; 95%CI: 1.1-6.62) and nephrotic range proteinuria (OR2.91; 95%CI: 1.2-7.1) were independent predictors for DN. Microhaematuria defined as ≥10 red blood cells per high-power field (OR0.032; 95%CI: 0.01-0.11) and overweight (OR0.21; 95%CI: 0.08-0.5) were independent predictors of NDRD. According to the predictive model based on the multivariate analysis, all patients with a score >3 had DN and 94% of cases with a score ≤1 had NDRD (score ranked from -6 to 8points). CONCLUSIONS NDRD is common in DM patients (39%), being primary glomerulonephritis the most frequent ethology. The absence of retinopathy and the presence of microhematuria are highly suggestive of NDRD. The use of our predictive model could facilitate the indication of performing a renal biopsy in DM patients.
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Affiliation(s)
- Florencio García-Martín
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Medicina, Universidad Complutense, Madrid, España.
| | | | | | - Teresa Bada Boch
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Manuel Praga Terente
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Medicina, Universidad Complutense, Madrid, España
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11
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Ren D, Kang W, Xu G. Meta-Analysis of Diagnostic Accuracy of Retinopathy for the Detection of Diabetic Kidney Disease in Adults With Type 2 Diabetes. Can J Diabetes 2019; 43:530-537.e4. [PMID: 31113753 DOI: 10.1016/j.jcjd.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/17/2019] [Accepted: 04/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The study aimed to explore whether diabetic retinopathy (DR) could distinguish diabetic kidney disease (DKD) from nondiabetic renal diseases (NDRDs) in patients with type 2 diabetes mellitus and renal disease. METHODS We searched PubMed, Embase, Cochrane, MEDLINE and China National Knowledge Internet for articles that enrolled patients with DKD and NDRD. The results were summarized as sensitivity, specificity and the area under the curve of summary receiver operating characteristic curve with their 95% confidence intervals (CIs). RESULTS A total of 51 studies that included 4,990 participants were collected for evaluation. The overall pooled sensitivity, specificity and area under the curve with their 95% CIs were 0.67 (95% CI 0.61, 0.73), 0.77 (95% CI 0.72, 0.81) and 0.78 (95% CI 0.75 to 0.82), respectively. If the test for DR is negative, the probability of DKD would decrease to 10%, but if the test for DR is positive, the probability would increase only to 42%. In addition, although the mean specificity of proliferative DR for detection of DKD was 0.98 (95% CI 0.92 to 1.00), the mean sensitivity was 0.25 (95% CI 0.16, 0.35). CONCLUSIONS DR may lack adequate evidence either to verify DKD or to exclude NDRD, and the severity of DR may not parallel the presence of DKD.
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Affiliation(s)
- Daijin Ren
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenling Kang
- Department of Nephrology, People's Hospital of Xinyu City, Xinyu, China
| | - Gaosi Xu
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
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12
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Liu D, Huang T, Chen N, Xu G, Zhang P, Luo Y, Wang Y, Lu T, Wang L, Xiong M, Geng J, Nie S. The modern spectrum of biopsy-proven renal disease in Chinese diabetic patients-a retrospective descriptive study. PeerJ 2018; 6:e4522. [PMID: 29607256 PMCID: PMC5877445 DOI: 10.7717/peerj.4522] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/28/2018] [Indexed: 11/20/2022] Open
Abstract
Background Renal biopsies performed in diabetic patients are increasing and becoming more complex. Comprehensive data on modern spectrum of biopsy-proven renal disease in Chinese diabetic patients are lacking. Methods In a nationwide renal biopsy survey including 71,151 native biopsies from 2004 to 2014, diabetic patients were identified according to the clinical diagnosis from referral records. The clinical data were extracted from referral records and pathological reports. Results A total of 1,604 diabetic patients, including 61 patients with T1DM, were analyzed in this study. The median age is 51.39 ± 11.37 years. Male patients accounted for 58% of the population. We found that only 44.7% of diabetic patients had the isolated pathological diagnosis of diabetic nephropathy (DN), while 49.1% had non-diabetic renal disease (NDRD) alone, and 6.2% had NDRD superimposed on DN. Nephrotic syndrome (n = 824, 51.4%) was the most common clinical indication for renal biopsy. Among 887 patients with NDRD, membranous nephropathy (n = 357) was the leading diagnosis, followed by IgA nephropathy (n = 179). Hypertensive renal disease (n = 32), tubulointerstitial nephropathy (n = 27) and acute tubular necrosis (n = 16) accounted for 3.5%, 2.9%, 1.7% of the NDRD cases respectively. Nearly a half (49.2%) of patients with T1DM had NDRD. Discussion Over 55% diabetic patients with kidney disease were diagnosed as non-diabetic renal disease, among which MN and IgAN were the most common two pathological types.
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Affiliation(s)
- Diankun Liu
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ting Huang
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Nan Chen
- Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Gang Xu
- Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Zhang
- Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, Chengdu, China
| | - Yang Luo
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yongping Wang
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tao Lu
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Long Wang
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mengqi Xiong
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Geng
- King Medical Diagnostics Center, Guangzhou, China.,School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Sheng Nie
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
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13
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Bhadauria D, Chellappan A, Kaul A, Etta P, Badri V, Kumar Sharma R, Prasad N, Gupta A, Jain M. Idiopathic membranous nephropathy in patients with diabetes mellitus: a diagnostic and therapeutic quandary! Clin Kidney J 2018; 11:46-50. [PMID: 29423200 PMCID: PMC5798118 DOI: 10.1093/ckj/sfx055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/19/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Proteinuria and renal dysfunction is common in diabetic patients and may occur due to variety of causes. Nondiabetic renal diseases (NDRD) account for 30% of the renal biopsies, and idiopathic membranous nephropathy (iMN) is a common non diabetic glomerular disease that can exist alone or in combination with diabetic nephropathy (DN). Immunosuppressants used in iMN may be associated with complications of worsening glycemic control and recurrent infections. There is a paucity of literature on the clinical course, outcomes and treatment adverse effects of patients with iMN and diabetes. METHODS We retrospectively analyzed the data of all diabetics, evaluated for NDRD and found to have iMN, between January 2000 and June 2015 in our institute. RESULTS A total of 134 patients with diabetes were biopsied for NDRD and 16 patients had iMN. Mean ± standard deviation age was 54 ± 11.77 years and the median duration of diabetes was 9.4 years. Twelve patients had isolated iMN and four patients had iMN coexisting with DN. Response rates of 18%, 35.71% and 63.63% were seen with Modified Ponticelli (MP) regimen, tacrolimus and mycophenolate mofetil (MMF), respectively. Five patients developed treatment-related adverse effects significant enough to necessitate a treatment change. Worsening glycemic control was the most common side effect. Adverse effects were less with the MMF compared with the MP regimen and tacrolimus. CONCLUSION Patients with iMN coexisting with diabetes exhibit a poor response to the MP regimen. Treatment-related toxicity is less common with MMF in comparison with the MP regimen and tacrolimus-based regimen. An almost similar response was noted with MMF and tacrolimus-based regimen but there was more withdrawal from treatment due to toxicities observed in the latter.
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Affiliation(s)
- Dharmendra Bhadauria
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anand Chellappan
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anupma Kaul
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Praveen Etta
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Vinay Badri
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Raj Kumar Sharma
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Narayan Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Amit Gupta
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Manoj Jain
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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14
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Erdogmus S, Kiremitci S, Celebi ZK, Akturk S, Duman N, Ates K, Erturk S, Nergizoglu G, Kutlay S, Sengul S, Ensari A, Keven K. Non-Diabetic Kidney Disease in Type 2 Diabetic Patients: Prevalence, Clinical Predictors and Outcomes. Kidney Blood Press Res 2017; 42:886-893. [PMID: 29130997 DOI: 10.1159/000484538] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/29/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Diabetic kidney disease (DKD) is one of the most frequent microvascular complications of diabetes and is the leading cause of end-stage kidney disease worldwide. In patients with diabetes, non-diabetic kidney disease (NDKD) can also occur. NDKD can be either alone or superimposed with the DKD. In this study, we aimed to investigate the utility of kidney biopsy in patients with type 2 diabetes mellitus (T2DM) and the predictability of diagnosing DKD versus NDKD from clinical and laboratory data. We also evaluated the prevalence and etiology of NDKD in patients with T2DM. METHODS We retrospectively reviewed type 2 diabetic patients who had kidney biopsy in the last 10 years for diagnosing possible NDKD in our center. In all patients kidney biopsies were performed because of atypical clinical features and biopsy samples were examined by light and immunofluorescence microscopy. Clinical parameters, laboratory workup and office blood pressures were recorded for each patient at the time of biopsy. RESULTS Eight patients were excluded due to missing data. A total of 48 patients (female/male: 26/22 and mean age: 59±8 years) were included in the study. According to the biopsy findings, 24 (50%) patients had NDKD alone, 20 (41.7%) had DKD alone and 4 (8.3%) had coexisting DKD and NDKD. The most common NDKD diagnoses were membranous nephropathy (29.2%), tubulointerstitial nephritis (20.8%) and IgA nephropathy (12.5%). There were no significant differences in three groups with respect to the duration of diabetes, proteinuria, hematuria and glycated hemoglobin A1c levels. Diabetic retinopathy (DR) was the most significant finding, which was associated with DKD. Positive and negative predictive values of DR for DKD were 88 and 81%, respectively. CONCLUSION This study demonstrated a high prevalence of NDKD in patients with T2DM. The absence of DR strongly predicted NDKD. Clinical decision alone can lead to wrong diagnosis and delay in appropriate therapy. Clinicians should consider the kidney biopsy more liberally when there is uncertainty on the exact etiology of the kidney disease. However, prospective multicenter studies are needed to clarify the prognosis and outcomes of patients with diabetics.
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Affiliation(s)
- Siyar Erdogmus
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Saba Kiremitci
- Ankara University School of Medicine, Department of Pathology, Ankara, Turkey
| | - Zeynep Kendi Celebi
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Serkan Akturk
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Neval Duman
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Kenan Ates
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Sehsuvar Erturk
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Gokhan Nergizoglu
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Sim Kutlay
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Sule Sengul
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Arzu Ensari
- Ankara University School of Medicine, Department of Pathology, Ankara, Turkey
| | - Kenan Keven
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
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15
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Urinary Neutrophil Gelatinase-Associated Lipocalin Is Complementary to Albuminuria in Diagnosis of Early-Stage Diabetic Kidney Disease in Type 2 Diabetes. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4691389. [PMID: 28845433 PMCID: PMC5563398 DOI: 10.1155/2017/4691389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/19/2017] [Accepted: 07/06/2017] [Indexed: 12/31/2022]
Abstract
Background Two clinical phenotypes of diabetic kidney disease (DKD) have been reported, that is, with or without increased albuminuria. The aim of study was to assess the usefulness of urinary neutrophil gelatinase-associated lipocalin (uNGAL) for the early diagnosis of DKD in the type 2 diabetes mellitus (T2DM). Methods The study group consisted of 123 patients with T2DM (mean age 62 ± 14 years), with urine albumin/creatinine ratio (uACR) < 300 mg/g and eGFR ≥ 60 ml/min/1.73 m2. The control group included 22 nondiabetic patients with comparable age, sex, and comorbidities. uNGAL, albumin, and creatinine were measured in the first morning urine samples. uACR and uNGAL/creatinine ratios (uNCR) were calculated. Results In the control group, maximum uNCR was 39.64 µg/g. In T2DM group, 24 patients (20%) had higher results, with the maximum value of 378.6 µg/g. Among patients with uNCR > 39.64 µg/g, 13 (54%) did not have markedly increased albuminuria. Women with T2DM had higher uNCR than men (p < 0.001), without difference in uACR (p = 0.09). uNCR in T2DM patients correlated significantly with HbA1c. Sex, total cholesterol, and uACR were independent predictors of uNCR above 39.64 µg/g. Conclusions Increased uNGAL and uNCR may indicate early tubular damage, associated with dyslipidemia and worse diabetes control, especially in females with T2DM.
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16
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Tanaka A, Nakamura T, Sato E, Node K. Therapeutic potential of tofogliflozin on nephrotic syndrome secondary to diabetic nephropathy. J Cardiol Cases 2017; 16:30-33. [PMID: 30279791 DOI: 10.1016/j.jccase.2017.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 11/16/2022] Open
Abstract
Diabetic nephropathy (DN) is a critical complication in patients with type 2 diabetes and regarded as a progressive disorder with a poor prognosis. The degree of albuminuria is associated closely with worse renal and cardiovascular outcomes. It is therefore important to achieve remission of proteinuria to avoid progression of DN and improve outcomes. Although a recent clinical trial demonstrated that a sodium glucose cotransporter 2 (SGLT2) inhibitor could improve cardiovascular and renal outcomes in cardiovascular high risk patients with type 2 diabetes, little is known whether SGLT2 inhibitors have favorably renal effects in patients with nephrotic syndrome associated with DN. Herein, we report a 54-year-old patient with refractory nephrotic syndrome accompanied by diabetic nephropathy. Tofogliflozin, a SGLT2 inhibitor, successfully increased urine volume, and reduced body weight, HbA1c, and urinary protein excretion (10.8 to 2.6 g/day) during 24 weeks. His severe edema also was diminished after administration of tofogliflozin. This case indicates that an SGLT2 inhibitor may be a useful choice in the treatment of patients with diabetic nephropathy and the nephrotic syndrome. <Learning objective: Little is known whether SGLT2 inhibitor can attenuate nephrotic-range of proteinuria in patients with diabetic nephropathy. The present case is the first to demonstrate that tofogliflozin markedly reduced urinary protein excretion, body weight, and relevant markers in patient with nephrotic syndrome secondary to diabetic nephropathy. Thus, it is suggested that SGLT2 inhibitor has a therapeutic potential to attenuate nephrotic syndrome-related symptoms and markers as well as glycemic control.>.
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Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Tsukasa Nakamura
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo, Japan
| | - Eiichi Sato
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
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17
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Li L, Zhang X, Li Z, Zhang R, Guo R, Yin Q, Yang L, Yue R, Su B, Huang S, Xu H, He C, Liu F. Renal pathological implications in type 2 diabetes mellitus patients with renal involvement. J Diabetes Complications 2017; 31:114-121. [PMID: 27838100 DOI: 10.1016/j.jdiacomp.2016.10.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 02/05/2023]
Abstract
AIMS To investigate the renal pathological implications in type 2 diabetes mellitus patients with renal involvement. METHODS A total of 328 type 2 diabetes mellitus (T2DM) patients with renal involvement who underwent a renal biopsy and received follow-up for at least one year were recruited in our study. The patients were divided into the diabetic nephropathy (DN), non-diabetic renal disease (NDRD), and NDRD superimposed on DN groups based on the pathological diagnosis. Renal outcomes were defined by the initiation of renal replacement therapy or doubling of the serum creatinine. Kaplan-Meier analysis was used to compare renal survival, and Cox proportional hazard analysis was used to determine the predictors of renal outcomes in the DN group. RESULTS Renal biopsy findings revealed that 188 patients (57.32%) had pure DN, 121 patients (36.89%) had NDRD alone, and 19 patients (5.79%) had NDRD superimposed on DN. The most frequent subclassification of NDRD was membranous nephropathy (MN). Compared with the NDRD and NDRD superimposed on DN groups, patients with pure DN had poorer renal function and lower renal survival rates. In the DN group, the five-year renal survival rates of glomerular classes of I, IIa, IIb, III and IV were 100%, 84.62%, 60%, 47.5% and 33.33%, respectively. Multivariate Cox proportional hazard analysis showed that the glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes, while interstitial fibrosis/inflammation and arteriolar hyalinosis were not independently associated with renal outcomes in the DN group. CONCLUSIONS Making an accurate pathologic diagnosis by renal biopsy is crucial for diabetes mellitus (DM) patients with renal involvement. The findings of our present study indicated that patients with pure DN had poorer renal outcomes than patients with NDRD or NDRD superimposed on DN. The classification of glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes in the DN group. More studies with large samples and longer time follow-up are needed to evaluate the relationship between pathological changes and clinical characteristics in T2DM patients who have renal involvement.
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Affiliation(s)
- Li Li
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Xiuhui Zhang
- Division of Pathology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Zhicheng Li
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Rui Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Ruikun Guo
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Qinghua Yin
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Lichuan Yang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Rongzheng Yue
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Baihai Su
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Songmin Huang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Huan Xu
- Division of Pathology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Cijiang He
- Division of Nephrology, Mount Sinai School of Medicine, New York, NY 10029, USA
| | - Fang Liu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
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18
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Liu S, Guo Q, Han H, Cui P, Liu X, Miao L, Zou H, Sun G. Clinicopathological characteristics of non-diabetic renal disease in patients with type 2 diabetes mellitus in a northeastern Chinese medical center: a retrospective analysis of 273 cases. Int Urol Nephrol 2016; 48:1691-8. [PMID: 27272256 PMCID: PMC5031732 DOI: 10.1007/s11255-016-1331-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/23/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the clinical and histopathological features of non-diabetic renal disease (NDRD) superimposed on diabetic nephropathy (DN) in northeastern Chinese patients with type 2 diabetes mellitus (T2D), and compare the changes with those of pure DN and isolated NDRD. METHODS Single-center retrospective analysis based on medical records of 273 patients (172 men, mean age: 51.1 ± 12.4 years) with T2D who underwent renal biopsy between February 2000 and October 2015. All patients were diagnosed as cases of pure DN, isolated NDRD or NDRD superimposed on DN. RESULTS Out of the 273 T2D patients, 68 (24.9 %) had DN, 175 (64.1 %) had NDRD, and 30 (11.0 %) had NDRD superimposed on DN. Idiopathic membranous nephropathy (IMN, 29.7 %) was the most common NDRD followed by IgA nephropathy (IgAN, 22.9 %), and hypertensive renal arteriolar sclerosis was the most common lesion in patients diagnosed as NDRD superimposed on DN. Patients with NDRD had a shorter duration of diabetes and lower frequencies of diabetic retinopathy (DR, 6.9 %) and renal failure (28.0 %), which is consistent with higher estimated glomerular filtration rates (eGFR) and lower systolic blood pressure (SBP). No significant between-group differences were observed with respect to proteinuria and hematuria. CONCLUSION Renal biopsy is strongly recommended for T2D patients to distinguish DN, NDRD and NDRD superimposed on DN, especially in patients with no signs of DR. This approach may help in early diagnosis and treatment of NDRD and improve renal outcomes in northeastern Chinese T2D patients.
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Affiliation(s)
- Shujun Liu
- The Department of Nephrology, Second Hospital of Jilin University, Changchun, 130041, Jilin, China
| | - Qiaoyan Guo
- The Department of Nephrology, Second Hospital of Jilin University, Changchun, 130041, Jilin, China
| | - Hongbo Han
- The Department of Endocrinology, 208th Hospital of PLA, Changchun, China
| | - Peihe Cui
- The Department of Nephrology, Second Hospital of Jilin University, Changchun, 130041, Jilin, China
| | - Xiao Liu
- The Department of Nephrology, Second Hospital of Jilin University, Changchun, 130041, Jilin, China
| | - Lining Miao
- The Department of Nephrology, Second Hospital of Jilin University, Changchun, 130041, Jilin, China
| | - Hongbin Zou
- The Department of Nephrology, Second Hospital of Jilin University, Changchun, 130041, Jilin, China
| | - Guangdong Sun
- The Department of Nephrology, Second Hospital of Jilin University, Changchun, 130041, Jilin, China.
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19
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The eye and the kidney: twin targets in diabetes. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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