Non-diabetic renal diseases in diabetics

Abstract

Abstract Diabetic nephropathy (DN) is a specific condition with a well-defined clinical course especially in type I diabetes. This is usually progressive and irreversible and does not have any specific treatment. But ‘diabetic nephropathy’ is not the only renal ailment found in diabetes. Renal conditions other than DN which are found in diabetics are collectively called non-diabetic renal disease. This is a heterogeneous mixture of glomerular and non-glomerular conditions. Although, some glomerulapathies were supposed to be more common in diabetics previously, a close review of various studies based on kidney biopsy, across the globe, suggests that the type and frequency of non-diabetic glomerular disease is dictated by indication of biopsy (proteinurea, hematurea, renal failure) and the underlying population studied. For example, in USA commonest lesion was focal and segmental glomerular sclerosis (FSGS), in Korea immunoglobulin A, in Iraq membranoproliferative glomerulonephritis (MPGN) and in India post infectious glomerulonephritis and interstitial nephritis. Ischemic nephropathy due to macrovascular diabetic complication, infections, chronic pyelonephritis, bladder dysfunction, obstructive uropathy, electrolyte abnormalities are common. Due to co-morbidities and various medications, episodes of acute kidney injury are also frequent. Many patients of primary renal diseases may develop drug-induced diabetes such as post transplant diabetes mellitus. Various conditions may co-exist with underlying DN. During evaluation of diabetic patients by nephrologist, a meticulous identification of all these non-diabetic renal conditions gives an opportunity to treat reversible conditions with specific therapy, help in renoprotection and helps in proper prognostication. A detailed classification of non-diabetic renal disease has been proposed for the benefit of clinicians.