Non-diabetic Renal Disease In Type Research Articles

Prevalence and Clinicopathological Characteristics of NDRD in Type 2 DM Patients

The prevalence of non-diabetic renal disease (NDRD) in type 2 diabetes mellitus (DM) varies depending on selection criteria and populations studied. Renal biopsies are not routinely performed in diabetic patients, but are indicated when NDRD is suspected. This study evaluated kidney biopsy histopathology and its correlation with clinical and biochemical parameters. Patients with type 2 DM who underwent renal biopsy for suspected NDRD from January 2015 to May 2023 were selected. Data analysis included clinical, laboratory, and histopathology findings. Patients were grouped as follows: Group I (pure diabetic nephropathy [DN]), Group II (NDRD with underlying DN), and Group III (pure NDRD). 41 biopsies were performed on type 2 DM patients. Mean age: 48.07±11.9 years, mean diabetes duration: 8.23±7.4 years, mean proteinuria: 11.37±8.0 mg/mmol, and mean creatinine: 2.19±2.05 mg/dl. 46.3% were hypertensives, 46.34% had diabetic retinopathy and 34.14% had hematuria. Among the studied group, 12 patients (29.26%) had pure DN, 10 patients (24.39%) had NDRD with underlying DN, and 19 patients (46.34%) had pure NDRD. The most common NDRD findings were membranous nephropathy 5 cases (26.31%) and focal segmental glomerulosclerosis 4 cases (21.05%). This study found a 46.34% incidence of NDRD in diabetic patients. NDRD should be suspected in atypical diabetic presentations, as early diagnosis and treatment may slow kidney disease progression.

Incidence, Histopathological Pattern, and Predictors of Non-Diabetic Renal Disease in Type 2 Diabetes Mellitus: A Single-Center Prospective Observational Study

Patients with type 2 diabetes mellitus (T2DM) may have renal involvement because of isolated diabetic nephropathy (DN), isolated non-diabetic renal disease (NDRD), or mixed lesions (DN combined with NDRD). This study was conducted to find out incidence, histopathological pattern, and clinical predictors of NDRD in the Kashmiri population. This is a single-center prospective observational study conducted from August 2015 to July 2017. Patients with T2DM presenting with atypical clinical features of renal involvement underwent kidney biopsy. A total of 33 patients were included. Isolated NDRD was found in 16/33 (48.5%) patients, isolated DN was discovered in 10/33 (30.3%), and mixed lesions in 7/33 (21.2%) patients. NDRD with or without DN was present in 23/33 (69.7%) patients. Overall, the most common renal histopathological lesion in NDRD was immunoglobulin A (IgA) nephropathy present in 7/23 (30.4%) patients. In mixed lesions, FSGS and TMA were the most common renal lesions present in 2/7 (28.57%) patients. The mean duration of diabetes in NDRD and isolated DN groups was 4.4±3.6 and 7.0±2.9 years, respectively (P = 0.04). NDRD was present in 21/23 (91.3%) patients without diabetic retinopathy (P = 0.016). Our data demonstrated that more than half of the patients with T2DM with atypical features had NDRD upon renal biopsy. The absence of diabetic retinopathy and a shorter duration of diabetes were indicators of NDRD. IgA nephropathy was the most prevalent renal pathology. Clinicians must consider kidney biopsy liberally, especially in patients with unclear etiology of a kidney disease. Patients with type 2 diabetes mellitus (T2DM) may have renal involvement because of isolated diabetic nephropathy (DN), isolated non-diabetic renal disease (NDRD), or mixed lesions (DN combined with NDRD). This study was conducted to find out incidence, histopathological pattern, and clinical predictors of NDRD in the Kashmiri population. This is a single-center prospective observational study conducted from August 2015 to July 2017. Patients with T2DM presenting with atypical clinical features of renal involvement underwent kidney biopsy. A total of 33 patients were included. Isolated NDRD was found in 16/33 (48.5%) patients, isolated DN was discovered in 10/33 (30.3%), and mixed lesions in 7/33 (21.2%) patients. NDRD with or without DN was present in 23/33 (69.7%) patients. Overall, the most common renal histopathological lesion in NDRD was immunoglobulin A (IgA) nephropathy present in 7/23 (30.4%) patients. In mixed lesions, FSGS and TMA were the most common renal lesions present in 2/7 (28.57%) patients. The mean duration of diabetes in NDRD and isolated DN groups was 4.4±3.6 and 7.0±2.9 years, respectively (P = 0.04). NDRD was present in 21/23 (91.3%) patients without diabetic retinopathy (P = 0.016). Our data demonstrated that more than half of the patients with T2DM with atypical features had NDRD upon renal biopsy. The absence of diabetic retinopathy and a shorter duration of diabetes were indicators of NDRD. IgA nephropathy was the most prevalent renal pathology. Clinicians must consider kidney biopsy liberally, especially in patients with unclear etiology of a kidney disease.

HISTOLOGICAL PATTERN OF NON-DIABETIC RENAL DISEASE IN TYPE 2 DIABETES MELLITUS. A STUDY IN A TERTIARY CARE HOSPITAL

ABSTRACT 
 OBJECTIVE: To determine the histological pattern of non-diabetic renal disease in type 2 diabetes mellitus.
 MATERIAL AND METHODS: This study was conducted in Nephrology department MTI Lady Reading Hospital Peshawar from January 2018 to January 2021. All type 2 diabetic patients with normal fundi were included in the study irrespective of time duration. Total of 30 patients were registered. Their bio data was entered in a prescribed proforma. Their fundoscopy was done. Those having normal fundi were included in the study and exposed to renal biopsy. Those patients having diabetic retinal changes were excluded from the study.
 RESULTS: Out of 30 patients, male were 20 and female were 10 with ratio of 2:1 with mean age of 55.5±13.3SD years. Pure diabetic nephropathy (DN) was noted in 9 (30%) cases, Non-Diabetic Renal Disease (NDRD) in 13 (43.3%) cases and NDRD on DN in 8 (26.7%) cases. Among the Non-Diabetic Renal Disease (NDRD), Membranous Glomerulonephritis (MGN) was present in 9 (30%) cases, Acute Tubular Necrosis (ATN) in 5 (16.6%) cases, Focal Segmental Glomerulosclerosis (FSGN) in 4 (13.33%.) cases, Mesangiocapillary Glomerulonephritis (MCGN) in 2 (6.7%) cases and Hemolytic Uremic Syndrome (HUS) in 1 (3.3%) cases.
 CONCLUSION: Early diagnosis of non-diabetic renal disease in type 2 diabetic patients benefits from early immunosuppressive therapy and prevent from CKD. Renal biopsy should be done in all patients with type 2 DM irrespective of time duration especially with normal fundi and atypical renal involvement.
 KEY WORDS: Renal biopsy, fundoscopy, non-diabetic renal disease, glomerulonephritis

Spectrum of non-diabetic renal disease in patients with diabetes mellitus in a tertiary care hospital

Aim and Objectives: To analyse frequency and spectrum of non diabetic renal disease (NDRD) in type 2 diabetes patients and also determine the clinical markers associated with NDRD. Methodology: Single centre based prospective observational study carried out during the period from M a y 2016 to September 2019. Type 2 DM patients with atypical clinical renal disease who underwent renal biopsy to rule out NDRD at King George Hospital, Visakhapatnam were included in the study. Results: In the present study, the overall prevalence of NDRD with or without underlying DN in our study was 71.7%. The prevalence rates of isolated NDRD, NDRD with DN and isolated DN were 51.2%, 20.5%, and 28.2% respectively. Shorter duration of diabetes, absence of retinopathy, presence of active urine sediment are markers associated with NDRD in type 2 diabetics and are strong indicators for biopsy. Isolated DN group patients suffer significantly with hypertension compared to NDRD group. Isolated NDRD group patients had low HbA1c (

Non-Diabetic Renal Disease in Type 2 Diabetic Patients with Nephropathy

Background: In diabetic patients a good proportion of nephropathy is due to nephropathy other than diabetic renal disease. The detection of superimposed primary nondiabetic renal disease in diabetic patients has an obvious prognostic and therapeutic importance.
 Objectives: To find out the proportion of diabetic subjects suffering from nondiabetic renal disease (NDRD) and to describe histological varieties in appropriate group.
 Materials and Methods: This crosssectional study was done in Department of Nephrology, Dhaka Medical College & Hospital, Dhaka from August 2015 to October 2016. Total 37 type 2 diabetic patients were selected. Renal biopsy was done and four cases were excluded due to inadequate sample. Tissue was sent for histopathology and direct immunofluorescence (DIF) examination. On the basis of histological diagnosis of biopsy reports patients were divided into three groups. Group I: Isolated NDRD, Group II: NDRD superimposed on diabetic nephropathy (mixed lesion) and Group III: Isolated diabetic nephropathy (DN). Each patient was evaluated for retinopathy from Ophthalmology department. Based on the presence or absence of retinopathy 33 patients were again divided into two groups. Group A includes patients with diabetic retinopathy (DR) and Group B includes patients without diabetic retinopathy.
 Results: NDRD was found in 57.6% cases, NDRD plus diabetic nephropathy (DN) in 21.2% and isolated DN in 21.2% cases. In Group A (patients with DR) NDRD, DN and mixed lesion were present in 7 (41.2%), 5 (29.4%) and 5 (29.4%) cases. In Group B (patients without DR) NDRD, DN and mixed lesion were present in 12 (75%), 2 (12.5%) and 2 (12.5%) cases respectively. p value (0.189) was not significant.
 Conclusion: Kidney disease other than diabetic nephropathy can occur in type 2 diabetic patients. In this study NDRD was found in high frequency. Lack of retinopathy is a poor predictor of nondiabetic kidney disease. Therefore, renal biopsy should be recommended in type 2 diabetic patients with risk factors of NDRD for accurate diagnosis, prompt initiation of disease-specific treatment and ultimately better renal outcome.
 J Enam Med Col 2020; 10(2): 73-78

Novel Model Predicts Diabetic Nephropathy in Type 2 Diabetes

Background: Clinical indicators for accurately distinguishing diabetic nephropathy (DN) from non-diabetic renal disease in type 2 diabetes (T2D) are lacking. This study aimed to develop and validate a nomogram for predicting DN in T2D patients with kidney disease. Methods: A total of 302 consecutive patients with T2D who underwent renal biopsy at China-Japan Friendship Hospital between January 2014 and June 2019 were included in the study. The data were randomly split into a training set containing 70% of the patients (n = 214) and a validation set containing the remaining 30% of patients (n = 88). Multivariable logistic regression analyses were applied to develop a prediction nomogram incorporating the candidates selected in the least absolute shrinkage and selection operator regression model. Discrimination, calibration, and clinical usefulness of the prediction model were assessed using a concordance index (C-index), calibration plot, and decision curve analysis. Both internal and external validations were assessed. Results: A multivariable model that included gender, diabetes duration, diabetic retinopathy, hematuria, glycated hemoglobin A1c, anemia, blood pressure, urinary protein excretion, and estimated glomerular filtration rate was represented as the nomogram. The model demonstrated very good discrimination with a C-index of 0.934 (95% CI 0.904–0.964). The calibration plot diagram of predicted probabilities against observed DN rates indicated excellent concordance. The C-index value was 0.91 for internal validation and 0.875 for external validation. Decision curve analysis demonstrated that the novel nomogram was clinically useful. Conclusion: The novel model was very useful for predicting DN in patients with T2D and kidney disease, and thereby could be used by clinicians either in triage or as a replacement for biopsy.

Design and validation of a scoring model for differential diagnosis of diabetic nephropathy and nondiabetic renal diseases in type 2 diabetic patients.

We aim to design a scoring model for differential diagnosis between diabetic nephropathy (DN) and nondiabetic renal disease (NDRD) in type 2 diabetic patients through a combination of clinical variables. A total of 170 patients with type 2 diabetes who underwent kidney biopsies were included and divided into three groups according to pathological findings: DN group (n = 46), MIX group (DN + NDRD, n = 54), NDRD group (n = 70). Clinical characteristics and laboratory data were collected and compared among groups. Variables with a significant statistical difference between DN and NDRD patients were analyzed by logistic regression to predict the presence of NDRD; then a scoring model was established based on the regression coefficient and further validated in an independent cohort of 67 patients prospectively. On biopsy, 72.9% of patients had NDRD, and the most common pathological type was membranous nephropathy. The established scoring model for predicting NDRD included five predictors: age, systolic blood pressure, hemoglobin, duration of diabetes, and absence of diabetic retinopathy. The model demonstrated good discrimination and calibration (area under curve [AUC] 0.863, 95% CI, 0.800-0.925; Hosmer-Lemeshow [H-L] P = .062). Furthermore, high prediction accuracy (AUC = 0.900; 95% CI, 0.815-0.985) in the validation cohort proved the stability of the model. We present a simple, robust scoring model for predicting the presence of NDRD with high accuracy (0.85) for the first time. This decision support tool provides a noninvasive method for differential diagnosis of DN and NDRD, which may help clinicians assess the risk-benefit ratio of kidney biopsy for type 2 diabetic patients with renal impairment.

Non-diabetic renal disease in patients with type 2 diabetes: a single centre study.

Non-diabetic renal disease (NDRD) has been widely known in diabetic patients. The clinical differentiation between diabetic nephropathy (DN) and NDRD is still not so clear and effective. To analyse the pathological characteristics and distribution of renal injury in selected type 2 diabetic patients. Comparison between DN and NDRD in clinical characteristics, to find important predictors for NDRD. To conduct retrospective analysis of clinical, laboratory and pathohistological data of type 2 diabetic patients in whom renal biopsies were performed from March 2010 to September 2014 in Shandong Provincial Hospital affiliated to Shandong University (n = 88). According to the findings of renal biopsy, the incidences of DN, NDRD and DN complicated with NDRD were 20.46, 72.73 and 6.82% respectively. The most common NDRD found were: membranous nephropathy, followed by IgA nephropathy and focal segmental glomerulosclerosis. In multivariate logistic-analysis, fasting blood glucose (odds ratio (OR) 0.714; 95% confidence interval (CI) = 0.543-0.939; P = 0.016) and absence of diabetic retinopathy (OR 18.602; 95% CI = 2.176-159.018; P = 0.003) were independent predictors of NDRD. This study confirmed a considerably high prevalence of NDRD in type 2 diabetic patients with renal injury. As some cases of NDRD are readily treatable or remittable, we should consider renal biopsy in selected diabetic patients with renal involvement, especially in those with effective blood glucose control and the absence of diabetic retinopathy.

Clinical and pathological characteristics of non-diabetic renal disease in type 2 diabetes patients.

ABSTRACTBackgroundRenal involvement in type 2 diabetes is mainly due to diabetic nephropathy (DN). Nevertheless, a sizable proportion of diabetic patients could actually have nondiabetic renal diseases (NDRDs) or DN plus NDRDs. This study aimed to explore the pathological features of NDRD in diabetic patients and to assess the predictability of diagnosing NDRD (±DN) versus isolated DN on the basis of clinical parameters.MethodsMedical records of type 2 diabetes patients who underwent renal biopsy under suspicion of NDRD from January 2011 through November 2015 were analyzed retrospectively.ResultsA total of 101 patients were enrolled in this study. The most frequent indication for renal biopsy was recent onset of nephrotic syndrome (41%), followed by rapidly progressive renal failure (29%) and active urinary sediment (21%). On renal biopsy, 51% of patients had isolated DN, 20% had isolated NDRD and 29% had DN plus NDRD. IgA nephropathy was the most common cause of isolated NDRD, whereas acute tubular necrosis (39%) and acute interstitial nephritis (33%) were the main causes of NDRD superimposed on DN. Male gender, short-duration diabetes (<8 years), lower glycated hemoglobin and active urinary sediment (≥10 red and white blood cells per high-power field) were independent predictors of NDRD according to multiple logistic regression analysis.ConclusionsJudicious use of renal biopsy revealed NDRD (±DN) in nearly half of type 2 diabetes patients with atypical renal presentation, especially in male patients with well-controlled diabetes, those who have had diabetes for a short duration and those with active urinary sediment.

Clinicopathological features of diabetic and nondiabetic renal diseases in type 2 diabetic patients with nephrotic-range proteinuria.

Heavy proteinuria with or without features of nephrotic syndrome is associated with many primary and systemic diseases. For diabetic patients, distinguishing nondiabetic renal disease (NDRD) from diabetic nephropathy (DN) is important in choosing treatment modalities and determining renal prognosis. However, clinical relevance of heavy proteinuria is inconsistent with clinical DN assessments. This study investigated the clinicopathological features and renal outcomes of DN and NDRD in type 2 diabetic patients with nephrotic-range proteinuria.We enrolled 220 cases of type 2 diabetic patients who underwent renal biopsy. They were grouped according to the presence of nephritic-range proteinuria and pathological features. Baseline characteristics, laboratory findings, types of pathological diagnosis, and renal outcomes were analyzed in patients with heavy proteinuria.Upon kidney biopsy, 129 patients (58.6%) showed nephritic-range proteinuria. Patients with heavy proteinuria (an average urine protein-to-creatinine ratio of 10,008 ± 7307 mg/gCr) showed lower serum albumin levels and higher total cholesterol levels, but did not show any difference in age, duration of diabetes, renal function, or the presence of retinopathy compared with those with mild-to-moderate proteinuria (an average urine protein-to-creatinine ratio of 1581 ± 979 mg/gCr). Renal biopsy revealed that the prevalence of NDRD was 37.2% in patients with heavy proteinuria, which was significantly lower than that in patients with mild-to-moderate proteinuria (63.7%). The most common pathological types of NDRD were membranous nephropathy (41.7%), IgA nephropathy (14.6%), and minimal change disease (10.4%). NDRD patients showed lower prevalence of diabetic retinopathy and better kidney function irrespective of proteinuria. Immunosuppressive treatment was administered more frequently in patients with heavy proteinuria (56.3%) compared with patients with mild-to-moderate proteinuria (20%) because of the pathological differences according to the amount of proteinuria. Renal outcomes were significantly worse in patients with DN than in patients with NDRD.DN patients with heavy proteinuria exhibited different prevalence of NDRD and worse prognosis. Renal biopsy in type 2 diabetic patients should be more extensively considered to accurately diagnose NDRD, guide further management, and predict renal outcomes, especially in patients with nephrotic-range proteinuria.

Clinicopathological study of nondiabetic renal disease in type 2 diabetic patients: A single center experience from India.

Diabetic nephropathy (DN) is a major complication of diabetes mellitus (DM), leading to chronic kidney disease/end-stage renal disease. Wide spectrum of nondiabetic renal diseases (NDRD) is reported in type-2 diabetes (type-2 DM). We carried out this single-center study to find clinical, laboratory, and histological features of NDRD in type-2 DM patients and to assess the prevalence of NDRD in India. A single-center retrospective study which included analysis of renal biopsies from patients with type-2 DM, performed between January 2008 and September 2016. Biopsy findings were categorized into three groups, Group-I (isolated NDRD); Group-II (NDRD superimposed on underlying DN); and Group-III (isolated DN). Out of 152 diabetic patients (111 males and 41 females), 35 (23.03%) patients were of Group-I (isolated NDRD), 35 (23.03%) of Group-II (NDRD superimposed on underlying DN), and 82 (53.95%) of Group-III (isolated DN). The mean age (in years) was 55.08 ± 10.71, 55.65 ± 8.71, and 54.45 ± 9.01 respectively in Group-I, II, and III. Nephrotic syndrome (NS) was the most common clinical presentation in all groups. Duration of DM was significantly shorter in Group-I than in Group-II. Diabetic retinopathy was absent in Group-I. Proteinuria was more in Group-III than Group-I. Low serum C3 and/or C4 levels was observed in five (14.29%) cases of Group-I and Group-II each and two (2.43%) cases of Group-III. Nearly, 70 (46.05%) patients were found to have NDRD either in isolated form or as combined lesions. The most common histological types of NDRD were acute tubulointerstitial nephritis (38.57%) followed by benign nephrosclerosis (15.72%), membranous nephropathy (10%), IgA nephropathy (7.14%), and membranoproliferative glomerulonephritis (7.14%). The incidence of NDRD (with/without DN) in type-2 DM is very high. Shorter duration of diabetes, hematuria, absence of retinopathy, low serum complement levels, and nephrotic range proteinuria are predictors of NDRD.

Non-diabetic renal disease in type 2 diabetes mellitus: Study of renal - retinal relationship.

Diabetic nephropathy (DN) has become the leading cause of end-stage renal disease worldwide. Non-diabetic renal disease (NDRD), is known to occur in diabetic patients. The renal and retinal relationship in type 2 diabetes mellitus (T2DM) with nephropathy is not uniform. This study was carried to study the histological spectrum of nephropathy in type 2 diabetic patients with proteinuria and its relationship with diabetic retinopathy (DR). Total 31 (males - 26; females - 5) proteinuric type 2 diabetic patients were studied. Average age of patients was 50.7 years. Nephrotic syndrome was noted in 21 (67.7%) patients. Overall, isolated DN, NDRD and NDRD superimposed on DN (mixed lesion) were observed in 12 (38.7%), 13 (41.9%) and 6 (19.4%) cases, respectively. DR was absent in 21/31 (67.7%) cases. The spectrum of nephropathy in patients without DR included: DN in 6 (28.57%), NDRD in 12 (57.14%) and mixed lesion in 3 (14.29%). Kidney histology in patients with DR (n-10) revealed DN in 6 (60%), NDRD in 1 (10%) and mixed lesion in 3 (30%) patients. Thus, absence of DR favors NDRD but does not exclude DN because isolated DN was noted in 28.57% cases in absence of DR. Similarly biopsy proven NDRD (pure NDRD; 10% and mixed lesion; 30%) was noted in 40% of cases in presence of DR. In summary, patients with T2DM had higher incidence of NDRD. DR is less frequent (32.3%) in type 2 diabetes and is a poor predictor of type of nephropathy. Hence, renal biopsy is essential for precise diagnosis of nephropathy in patients with T2DM.

Predicting non-diabetic renal disease in type 2 diabetic adults: The value of glycated hemoglobin

AimsThe indications for renal biopsy in type 2 diabetes mellitus (T2D) are not well established. We investigated the prevalence, spectrum, and predictors of biopsy-proven non-diabetic renal disease (NDRD) in T2D. MethodsAn observational, single-center, retrospective study of T2D adults who underwent renal biopsies (N=51) over 10years for nephrotic-range proteinuria, microscopic hematuria, or rapidly declining renal function. ResultsThirty-five (68.6%) biopsies were diagnostic of NDRD, and 16 (31.4%) revealed isolated diabetic nephropathy. The most common NDRDs were interstitial nephritis (20%), progressive crescentic glomerulonephritis (14%), membranous nephropathy (11%), and focal segmental glomerulosclerosis (11%). The odds for NDRD declined by 97% in the presence of diabetic retinopathy (P<0.001). The deterioration of HbA1c during the year before biopsy predicted NDRD even after adjusting for diabetic retinopathy (OR, 7.65; 95% CI, 1.36–123.04; P=0.003). A model based on the interaction between the HbA1c values 12months before biopsy and the absolute change in these values during the preceding year predicted NDRD with 73.7% sensitivity and 75% specificity (AUC, 0.77; 95% CI, 0.59–0.94). ConclusionsThis study demonstrated a considerably high prevalence of NDRD in T2D adults undergoing renal biopsy. The absence of diabetic retinopathy, lower HbA1c values 12months before biopsy and greater deterioration in HbA1c prior to biopsy predicted NDRD in T2D. Further studies are needed to validate the findings.

Clinical Challenges in Diagnosis and Management of Diabetic Kidney Disease

Diabetic kidney disease (DKD) is a major and increasing worldwide public health issue. There is a great need for implementing treatments that either prevent or significantly slow the progression of DKD. Although there have been significant improvements in management, the increasing numbers of patients with DKD illustrate that current management is not wholly adequate. The reasons for suboptimal management include the lack of early diagnosis, lack of aggressive interventions, and lack of understanding about which interventions are most successful. There are a number of challenges and controversies regarding the current management of patients with DKD. Understanding of these issues is needed in order to provide the best care to patients with DKD. This article describes some of the clinically important challenges associated with DKD: the current epidemiology and cost burden and the role of biopsy in the diagnosis of DKD. Treatment controversies regarding current pharmacologic and nonpharmacologic approaches are reviewed and recommendations based on the published literature are made.

Nondiabetic Renal Disease in type 2 Diabetes Mellitus Patients: A Clinicopathological Study

Background:The prevalence of nondiabetic renal disease (NDRD) among type 2 diabetics varies widely depending on the populations being studied and the selection criteria. Also, for patients found to have NDRD different predicting factors have been identified by different studies.Objectives:To determine: (i) Frequency and spectrum of NDRD in type 2 diabetics with atypical clinical renal disease, in our set up and (ii) common clinical markers that are associated with NDRD in our local population.Materials and Methods:Ninety-three type 2 diabetic patients with atypical clinical renal disease who had undergone renal biopsy to rule out NDRD were recruited. Patients were grouped into Group 1 with isolated NDRD, Group 2 with NDRD superimposed on diabetic nephropathy (DN), and Group 3 with isolated DN; and their clinical and biochemical parameters were statistically analyzed using analysis of variance, Kruskal-Wallis test, and Chi-square tests of statistical significance.Results:68.8% of the patients had NDRD with or without concurrent DN. Patients with isolated NDRD had shorter duration of diabetes compared to the other groups. Absence of retinopathy and presence of microscopic hematuria and active urinary sediment had positive predictive value of 79.24, 81, and 100%, respectively, for NDRD in type 2 diabetics. Chronic interstitial nephritis was the commonest NDRD and membranous glomerulonephritis was the commonest glomerular NDRD in our setup.Interpretation and Conclusions:The frequency of NDRD in type 2 diabetics with atypical clinical renal disease is high in our setup thereby making the renal biopsy procedure imperative to rule out the same. Shorter duration of diabetes, absence of retinopathy, presence of microscopic hematuria, and active urinary sediment are markers associated with NDRD in type 2 diabetes with clinical renal disease.

Nondiabetic kidney disease in type 2 diabetic patients: A single center experience.

Nondiabetic renal disease (NDRD) is seen as a cause of proteinuria and renal failure in type 2 diabetes mellitus (DM). The clinical differences between NDRD and diabetic glomerulosclerosis (DGS) are not clear. This study was done to find the spectrum of NDRD in type 2 DM patients and differences in clinical profile between NDRD and DGS patients. Data of patients with type 2 DM who underwent renal biopsy in this institute from 1990 to 2008 were analyzed retrospectively. Patients were categorized as isolated NDRD, NDRD with DGS, and isolated DGS. A total of 75 patients were included. Mean age was 45 ± 10.2 years, male to female ratio was 3.1 : 1, median duration of DM was 12 months (range, 1 year-15 years), proteinuria was 4.2 ± 3.4 g/day, and serum creatinine was 4.3 ± 3.9 mg/dl. Hypertension was observed in 63 (84%) cases and microscopic hematuria in 24 (32%) cases. Nephrotic syndrome (38.7%) was the commonest clinical presentation. Forty-eight (64%) cases had NDRD and 27 (36%) had DGS. The commonest NDRD was minimal change disease (12.5%). Three (6.3%) patients had lupus nephritis. Tubulointerstitial nephritis has been observed in 10.4% patients. No significant differences between NDRD and DGS patients were found except hypertension which was significantly high in the DGS group. Acute kidney injury and nephritic syndrome were not observed in the DGS group. In conclusion, the incidence of biopsy-proven NDRD in type 2 DM in this study was high. Kidney biopsy aided in the detection of NDRD in clinically suspected patients.

Nondiabetic Renal Disease in Type 2 Diabetic Patients: A Review of our Experience in 220 Cases

Background: The purpose of this retrospective study was to evaluate the renal biopsies performed on type 2 diabetic patients for suspicion of nondiabetic renal disease (NDRD) and to correlate the pathological finding with the clinical and laboratory findings. Methods: From January 1999 to December 2009, 220 people with type 2 diabetes for clinically suspected NDRD underwent renal biopsy. The case records of these patients were retrospectively analyzed. Based on the biopsy findings, patients were divided into two groups: Group I, isolated diabetic glomerulosclerosis (DGS), and Group II, NDRD with underlying DGS. Clinical and laboratory data were analyzed in relation to the histopathological findings. Results: Of the 220 patients studied, 153 were males and 67 were females. The average age was 51.35 years (30–79). Renal biopsy showed that 100 patients (45.5%) had NDRD with underlying DGS. Group II had a significantly higher level of proteinuria and hematuria but less frequent diabetic retinopathy. There was no significant difference between the two groups in age, duration of diabetes, presence of hypertension, serum creatinine, and glomerular filtration rate. IgA nephropathy was the most common, accounting for 34% of Group II, membranous nephropathy ranked second accounting for 22.0%, followed by mesangial proliferative nephritis for 14%. Conclusion: This study showed that IgA nephropathy is the commonest NDRD among diabetics. The absence of retinopathy, especially when associated with nephritic proteinuria and hematuria, strongly predicts NDRD superimposed on DGS. Renal biopsy should be performed in diabetics when the clinical scenario is atypical.

Clinical indicators which necessitate renal biopsy in type 2 diabetes mellitus patients with renal disease

The diagnosis of diabetic nephropathy (DN) is always based on clinical grounds. However, the necessity for renal biopsy of type 2 diabetes mellitus (DM) patients with renal disease to establish the diagnosis remains unclear. We retrospectively studied 50 type 2 diabetic patients performed with renal biopsy between December 2002 and December 2006. Based on renal pathology, patients were divided into group I: DN alone, group II: non-diabetic renal disease (NDRD) superimposed on DN and group III: isolated NDRD. Factors like DM > 10 years, retinopathy, previous minimal proteinuria without sudden heavy proteinuria, no glomerular haematuria and non-small-sized kidney were collected to evaluate their sensitivity, specificity, positive predictive value and negative predictive value for prediction of DN or NDRD in type 2 diabetic patients. Group I consisted of 24 patients, group II 15 patients and group III 11 patients. Acute interstitial nephritis was the most prevalent second renal disease in our study. Sensitivity and specificity for group I was poor in five features except high sensitivity in no sudden heavy proteinuria (83.3%) and non-small-sized kidney (95.8%). Comparable retinopathy, sudden heavy proteinuria and haematuria (p > 0.05) was noted between the three groups. Significant biopsy indicators included higher serum albumin, lower urinary daily protein excretion and lower 24-h creatinine clearance (C(Cr)) rate (p < 0.05). Our study demonstrated that DM > 10 years and retinopathy did not exclude NDRD in type 2 DM patients, and need for renal biopsy. Higher serum albumin, lower urinary daily protein and 24-h C(Cr) were indicative for biopsy to exclude NDRD.