Non-Diabetic Renal Disease in Patients with Type 2 Diabetes Mellitus with Proteinuria

Manik Chandra Mondal,Popy Sarker,A K M Shahidur Rahman,Fahad Al Shatil Ashrafee,Shah Md Zakir Hossain,Mohammad Kamrul Ahsan,K B M Hadiuzzaman,Rana Mokarrom Hossain,Abu Zafor Md Salahuddin,Md Omar Faroque

doi:10.4236/jbm.2019.712007

Abstract

Background: Diabetes mellitus (DM) is the leading cause of end stage renal disease (ESRD) worldwide. Although DM with proteinuria is the ultimate result of diabetic nephropathy (DN), a wide spectrum of non-diabetic renal diseases (NDRD) can occur in such patients. Objective: To observe the frequency and histological pattern of NDRD in diabetic patients with proteinuria and to explore their association with clinical and laboratory parameters. Methods: This cross-sectional study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2016 to September 2017. In this study a total of 38 cases of DM with proteinuria (>1 gm/24-hour) were selected purposively. Renal biopsy was done in all patients. Based on histological findings they were categorized into two groups; Group 1 with NDRD and Group II with DN. Their clinical and laboratory parameters were analyzed and compared. Results: Among the total study subjects, 21 (55.3%) were male and 17 (44.7%) were female, mean (±SD) age 43.45 ± 9.99 years in the NDRD group and 41.57 ± 9.50 years in the DN group. Thirty one cases (81.6%) out of thirty eight had NDRD and seven (18.4%) cases had isolated DN; therefore more than two third cases had NDRD. Duration of DM was found to be significantly shorter (p = 0.004) in the NDRD group. Diabetic retinopathy was present in 12.9% cases in NDRD group vs. 57.1% cases in DN group (p = 0.025). Frequency of microscopic hematuria was significantly higher (90.3%) in NDRD patients (p = 0.002). Conclusion: The frequency of NDRD in type 2 diabetic patients other than diabetic nephropathy is relatively high. Membrano proliferative glomeru-lonephritis and membranous nephropathy are more common in NDRD. Absence of diabetic retinopathy, presence of hematuria and shorter duration of DM are markers associated with NDRD in type 2 DM, which are important indicators for renal biopsy in diabetic patients with proteinuria.

Highlights

Diabetes mellitus (DM) is a silent killer affecting several organs with a wide range of microvascular and macrovascular complications
DM with proteinuria is the ultimate result of diabetic nephropathy (DN), a wide spectrum of non-diabetic renal diseases (NDRD) can occur in such patients
Apart from diabetic nephropathy there are other diseases that affect the kidneys in diabetic patients known as non diabetic renal disease (NDRD) that can be confirmed by renal biopsy [4]

Summary

Introduction

Diabetes mellitus (DM) is a silent killer affecting several organs with a wide range of microvascular and macrovascular complications. In the case of diabetes mellitus, diabetic nephropathy is almost always diagnosed clinically based on a long history of diabetes, presence of other microvascular complications and evidenced by proteinuria prior to renal failure [4]. DM with proteinuria is the ultimate result of diabetic nephropathy (DN), a wide spectrum of non-diabetic renal diseases (NDRD) can occur in such patients. Objective: To observe the frequency and histological pattern of NDRD in diabetic patients with proteinuria and to explore their association with clinical and laboratory parameters. Presence of hematuria and shorter duration of DM are markers associated with NDRD in type 2 DM, which are important indicators for renal biopsy in diabetic patients with proteinuria

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Conclusion