Abstract
Background: Diabetic nephropathy (DN) is the dominant reason for end-stage kidney disease linked with a rise in cardiovascular mortality rate. However, besides DN, type 2 diabetic patients may also suffer from various non-diabetic renal diseases (NDRD). Aim: The objective of the current research was to assess the occurrence and type of NDRD diagnosed by kidney biopsy in type 2 diabetic subjects, evaluate the association of various clinical and laboratory characteristics with histopathology findings, and identify essential predictors of NDRD. Methods: Retrospective analysis has been performed through medical record revision of 101 patients with type 2 diabetes undergoing percutaneous renal biopsy at Qilu Hospital of Shandong University (Jinan, China) between January 2015 and December 2020. Results: Renal biopsy results showed that NDRD was found in 59 patients (58.42%), while DN existed in 32 patients (31.68%) and 10 patients (9.90%) showed DN complicated with NDRD. Membranous nephropathy was prevailing NDRD (42%), followed by focal segmental glomerulosclerosis (11.6%) and IgA nephropathy (10.1%). In univariate analysis, patients with NDRD had older age (p < 0.018), a short duration of diabetes (p < 0.000), lower proteinuria (p < 0.030), and had higher hemoglobin levels (p < 0.006) compared to non-NDRD patients. In multivariate logistic regression analysis, the short course of diabetes (OR 0.986; 95% CI = 0.978 - 0.993; p = 0.000) and older age (OR 1.080; 95% CI = 1.028 - 1.134; p = 0.002) were significant risk factors for NDRD occurrence. In ROC analysis for NDRD, the duration of diabetes ≤ 78 months (cut-off value (0.725, 0.313)) illustrated the highest AUC. Conclusions: Clinical parameters such as short duration of diabetes, older age, higher hemoglobin level, and lower proteinuria might be associated with NDRD in type 2 diabetic patients. An early diagnosis of NDRD poses a favorable renal prognosis because it requires a different approach than DN, further larger multicenter randomized prospective investigations focused on identifying possible risk markers of NDRD are still in priority.
Highlights
Diabetes mellitus (DM), which is considered a public health threat, affects various organs and results in different vascular and non-vascular complications
Renal biopsy results showed that non-diabetic renal diseases (NDRD) was found in 59 patients (58.42%), while Diabetic nephropathy (DN) existed in 32 patients (31.68%) and 10 patients (9.90%) showed DN complicated with NDRD
In receiver operating characteristic (ROC) analysis for NDRD, the duration of diabetes ≤ 78 months (cut-off value (0.725, 0.313)) illustrated the highest areas under the ROC curves (AUC). Clinical parameters such as short duration of diabetes, older age, higher hemoglobin level, and lower proteinuria might be associated with NDRD in type 2 diabetic patients
Summary
Diabetes mellitus (DM), which is considered a public health threat, affects various organs and results in different vascular and non-vascular complications. Besides DN, type 2 diabetic patients may suffer from various non-diabetic renal diseases (NDRD). Patients with NDRD had older age (p < 0.018), a short duration of diabetes (p < 0.000), lower proteinuria (p < 0.030), and had higher hemoglobin levels (p < 0.006) compared to non-NDRD patients. In multivariate logistic regression analysis, the short course of diabetes (OR 0.986; 95% CI = 0.978 - 0.993; p = 0.000) and older age (OR 1.080; 95% CI = 1.028 1.134; p = 0.002) were significant risk factors for NDRD occurrence. Conclusions: Clinical parameters such as short duration of diabetes, older age, higher hemoglobin level, and lower proteinuria might be associated with NDRD in type 2 diabetic patients. An early diagnosis of NDRD poses a favorable renal prognosis because it requires
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