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.

Shujun Liu,Hongbin Zou,Xiao Liu,Peihe Cui,Qiaoyan Guo,Hongbo Han,Lining Miao,Guangdong Sun

doi:10.1007/s11255-016-1331-y

Abstract

ObjectiveTo 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.MethodsSingle-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.ResultsOut 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.ConclusionRenal 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.

Highlights

With the rising prevalence of diabetes mellitus (DM), diabetic nephropathy (DN) is the most common cause of end stage-renal disease (ESRD) worldwide [1]
Renal biopsy is strongly recommended for type 2 diabetes mellitus (T2D) patients to distinguish DN, non-diabetic renal disease (NDRD) and NDRD superimposed on DN, especially in patients with no signs of DR
Age at biopsy mean ± standard deviation (SD) Sex Duration of DM Insulin treatment Diabetic retinopathy Nephrotic syndrome Renal failure Hypertension Dyslipidemia renin– angiotensin–aldosterone system (RAAS) blockade therapy Body mass index 24 h-urinary protein (g) Proteinuria (%) Hematuria (%) Pathological diagnosis Diabetic nephropathy (DN) Non-diabetic renal disease (NDRD) NDRD superimposed on DN

Summary

Introduction

With the rising prevalence of diabetes mellitus (DM), diabetic nephropathy (DN) is the most common cause of end stage-renal disease (ESRD) worldwide [1]. Non-diabetic renal disease such as IgA nephropathy (IgAN), membranous nephropathy (MN) and mesangioproliferative glomerulonephritis (MPGN) may coexist with DN. Differentiation between DN and non-diabetic renal disease (NDRD) may not be possible without renal biopsy. Identification of NDRD with renal biopsy may help guide specific alteration in treatment and, thereby, improve prognosis [6, 7]. The indications for renal biopsy in type 2 diabetic patients with NDRD include a recent history of DM, lower HbA1c levels, and normal blood pressure (BP), absence of DR, rapid decline in renal function, Int Urol Nephrol (2016) 48:1691–1698 increasing proteinuria, active urine sediment or acute onset of nephrotic syndrome (NS) [6, 8, 9]

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Results

Conclusion