Abstract
The majority of diabetic patients with renal involvement are not biopsied. Studies evaluating histological findings in renal biopsies performed in diabetic patients have shown that approximately one third of the cases will show pure diabetic nephropathy, one third a non-diabetic condition and another third will show diabetic nephropathy with a superimposed disease. Early diagnosis of treatable non-diabetic diseases in diabetic patients is important to ameliorate renal prognosis. The publication of the International Consensus Document for the classification of type 1 and type 2 diabetes has provided common criteria for the classification of diabetic nephropathy and its utility to stratify risk for renal failure has already been demonstrated in different retrospective studies. The availability of new drugs with the potential to modify the natural history of diabetic nephropathy has raised the question whether renal biopsies may allow a better design of clinical trials aimed to delay the progression of chronic kidney disease in diabetic patients.
Highlights
Diabetes mellitus (DM) represents one of the most important health problems worldwide
Renal biopsy is indicated in diabetic patients with an atypical presentation of renal disease that could be attributed to other renal entities different from diabetic nephropathy
The preferred term for renal disease in diabetics is diabetic kidney disease, while the term diabetic nephropathy is only employed in cases with histological confirmation
Summary
Diabetes mellitus (DM) represents one of the most important health problems worldwide. Organization foresees an increase in the global prevalence of DM from 2.8% in year 2000 to 4.4% in year 2030. This estimation represents that there will be 366 million adults with diabetes in 2030 [1]. Diabetes Mellitus is the fifth-leading cause of death worldwide and is associated with an increased risk of cardiovascular disease [4]. Chronic kidney disease (CKD) is a common complication in diabetic patients and further contributes to increased mortality and cardiovascular disease. Diabetic nephropathy is the most common cause of end-stage renal disease in Western Societies, accounting for approximately 45% of patients on renal replacement therapy. Patient survival in diabetics on maintenance dialysis is lower than in non-diabetic patients with end-stage renal disease due to other renal diseases [6]
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