Histological Pattern of Renal Disease in Those with Type 2 Diabetes Mellitus (T2DM)

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The prevalence of nondiabetic renal disease in those with T2DM is very common in multiple series across the world, however, data from India is limited. This study was done by including all subjects of T2DM; who underwent renal biopsies at EMS Memorial Cooperative Hospital, Perinthalmanna, Kerala, India, from September 2009 to August 2016. Seventy-one (Males:47, Females:24, Mean age: 52.93; SD 12.56 years) subjects with T2DM; who underwent renal biopsy; with a suspicion of non-diabetic renal disease were included. The indications for renal biopsy were: acute on chronic renal failure (ACRF) (35.2%), nephrotic syndrome (NS) (31%), acute renal failure (ARF) (14.1%), nephritic syndrome (14.1%), rapidly progressive renal failure (RPRF) (4.2%) and subnephrotic protienuria (1.4%). The prevalence rates of nondiabetic renal disease (NDRD), diabetic nephropathy (DN) and DN with NDRD were 50.71, 28.16 and 21.13 % respectively. The mean durations of T2DM were 12.45, 12.13 and 5.33 years in patients with DN, DN & NDRD and NDRD, respectively. Wide spectrum of glomerular diseases was observed among those with isolated NDRD; commonest being IgA nephropathy (IgAN) (9.86 %), followed by infection related glomerulonephritis (IRGN) (7.04 %), membranous nephropathy (MN) (5.63%), focal segmental glomerulosclerosis (FSGS) (4.22 %) and miscellaneous (14.1%) lesions. The acute interstitial nephritis (AIN) was the commonest of the tubulointerstitial diseases (TIDs) in those with isolated NDRD. Among the patients with DN with associated NDRD, acute tubular necrosis (ATN) (7.04%) and IRGN (5.63%) were the commonest associated lesions. This study underlines the importance of renal biopsy in patients of T2DM with atypical features.