POS-041 Clinico-histopathologic Profile and Prognostication of Infection Related Glomerulonephritis in Diabetes Mellitus

Abstract

Diabetes mellitus is the most leading cause for renal dysfunction in India. The metabolic derangement, puts the individual at high risk of infection and is often associated with acute renal dysfunction secondary to immune mediated Infection Related Glomerulonephritis (IRGN). Diabetics are 6 times more likely to develop IRGN as per regional data. Unlike in children, IRGN in diabetic population has grave prognosis with many moving into dialysis dependent renal failure. The aim of this study was to determine the clinical profile & histopathological patterns of patients presenting with (IRGN) in diabetics and to assess the risks factors for progression to CKD/ ESRD All diabetic patients with biopsy proven IRGN between the period of January 2017 and August 2021 was included. Clinical characteristics, laboratory data, renal biopsy reports and follow up data were obtained. Factors affecting outcomes were studied. Data was presented as mean with standard deviation. Multivariate regression analysis was performed to identify independent risk factors that predicted adverse outcomes 40 patients of diabetic IRGN was included in study, consisting predominantly of males (60%). The mean age was 53.08 ± 10 yrs and duration of diabetes was 6.86 ± 4 yrs. Volume overload (92%) dominated in presentation with 22(55%) requiring dialysis. Diabetic foot (35%) was most common trigger, while no foci identified in 37.5%. The mean C3 and C4 levels were 53.5±19.2mg/dl and 19.1±2.4mg/dl, while normo-complementemia found in 10%. Complete renal recovery ensued in 15 patients (37.5%), while 12 (30%) progressed to ESRD. Crescentic glomerulonephritis was noted in 17 patients (42%). Anuria, diabetic retinopathy, interstitial inflammation/edema, arterial hyalinosis, coexisting IgG deposition, glomerulosclerosis > 30% and IFTA >30% correlated with progression to ESRD. No relation noted between creatinine, ATI, endocapillary proliferation, crescents, complement levels to outcome. Infection Related Glomerulonephritis in diabetics can have poor renal prognosis. Anuria, Diabetic Retinopathy, Co-existing Diabetic Nephropathy, Intense interstitial inflammation, Glomerulosclerosis >30% and IFTA>30% were predictive of poor renal recovery. Crescents and complement levels showed no relation to renal outcome. Nearly two third of adult diabetics with IRGN progress to CKD and approximatly half of whom may endup as dialysis dependent renal failure.The entity overall has very poor outcomes in caomparison to that of childhood IRGN