Incidence, Histopathological Pattern, and Predictors of Non-Diabetic Renal Disease in Type 2 Diabetes Mellitus: A Single-Center Prospective Observational Study
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Keywords
diabetic nephropathy, diabetic retinopathy, focal segmental glomerulosclersosis, IgA nephropathy, non-diabetic renal disease
Abstract
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.
References
2. Afkarian M, Sachs MC, Kestenbaum B, Hirsch IB, Tuttle KR, Himmelfarb J, et al. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol. 2013 Feb 1;24(2):302–8. 10.1681/ASN.2012070718
3. de Boer IH, Rue TC, Hall YN, Heagerty PJ, Weiss NS, Himmelfarb J. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA. 2011 Jun 22;305(24):2532–9. 10.1001/jama.2011.861
4. Zhang L, Long J, Jiang W, Shi Y, He X, Zhou Z, et al. Trends in chronic kidney disease in China. New Engl J Med. 2016 Sep 1;375(9):905–6. 10.1056/NEJMc1602469
5. Huang F, Yang Q, Chen L, Tang S, Liu W, Yu X. Renal pathological change in patients with type 2 diabetes is not always diabetic nephropathy: A report of 52 cases. Clin Nephrol. 2007 May 1;67(5):293–7. 10.5414/CNP67293
6. Prakash J, Sen D, Usha KNS. Non-diabetic renal disease in patients with type 2 diabetes mellitus. J Assoc Phys Ind. 2007;49:415–20.
7. Yaqub S, Kashif W, Hussain SA. Non-diabetic renal disease in patients with type-2 diabetes mellitus. Saudi J Kidney Dis Transplant. 2012;23(5):1000–07. 10.4103/1319-2442.100882
8. Soni SS, Gowrishankar S, Kishan AG, Raman A. Non-diabetic renal disease in type 2 diabetes mellitus. Nephrology. 2006 Dec;11(6):533–7. 10.1111/j.1440-1797.2006.00681.x
9. Pham TT, Sim JJ, Kujubu DA, Liu IL, Kumar VA. Prevalence of nondiabetic renal disease in diabetic patients. Am J Nephrol. 2007;27(3):322–8. 10.1159/000102598
10. Mou S, Wang Q, Liu J, Che X, Zhang M, Cao L, et al. Prevalence of non-diabetic renal disease in patients with type 2 diabetes. Diabetes Res Clin Pract. 2010;87:354–9. 10.1016/j.diabres.2009.11.012
11. Prasad N, Veeranki V, Bhadauria D, Kushwaha R, Meyyappan J, Kaul A, et al. Non-diabetic kidney disease in type 2 diabetes mellitus: A changing spectrum with therapeutic ascendancy. J Clin Med. 2023 Feb 20;12(4):1705. 10.3390/jcm12041705
12. Zeng YQ, Yang YX, Guan CJ, Guo ZW, Li B, Yu HY, et al. Clinical predictors for non-diabetic kidney diseases in patients with type 2 diabetes mellitus: A retrospective study from 2017 to 2021. BMC Endocr Disord. 2022 Jun 30;22(1):168. 10.1186/s12902-022-01082-8
13. Kritmetapak K, Anutrakulchai S, Pongchaiyakul C, Puapairoj A. Clinical and pathological characteristics of non-diabetic renal disease in type 2 diabetes patients. Clin Kidney J. 2018 Jun;11(3):342–347. 10.1093/ckj/sfx111
14. Chang TI, Park JT, Kim JK, Kim SJ, Oh HJ, Yoo DE, et al. Renal outcomes in patients with type 2 diabetes with or without coexisting non-diabetic renal disease. Diabetes Res Clin Pract. 2011 May 1;92(2):198–204. 10.1016/j.diabres.2011.01.017
15. Erdogmus S, Kiremitci S, Celebi ZK, Akturk S, Duman N, Ates K, et al. Non-diabetic kidney disease in type 2 diabetic patients: Prevalence, clinical predictors and outcomes. Kidney Blood Press Res. 2017;42(5):886–93. 10.1159/000484538
16. Sharma M, Parry MA, Jeelani H, Mahanta PJ, Doley PK, Pegu G. Prevalence of nondiabetic renal disease in patients with type 2 diabetes mellitus with clinicopathological correlation: A study from a tertiary care center of Assam, India. Saudi J Kidney Dis Transplant. 2020 Jul 1;31(4):831–9. 10.4103/1319-2442.292318
17. Okada T, Nagao T, Matsumoto H, Nagaoka Y, Wada T, Nakao T. Clinical significance of microscopic haematuria in diabetic nephropathy in type 2 diabetes patients with overt proteinuria. Nephrology. 2013 Aug;18(8):563–8. 10.1111/nep.12104
18. Wirta O, Helin H, Mustonen J, Kuittinen E, Savela T, Pasternack A. Renal findings and glomerular pathology in diabetic subjects. Nephron. 2000;84(3):236–42. 10.1159/000045583
19. Imtiaz S, Salman B, Nasir K, Drohlia MF, Ahmad A. Clinical variables differentiating diabetic from nondiabetic kidney disease in patients with diabetes: A single-center study. Saudi J Kidney Dis Transplant. 2017 Mar 1;28(2):307–12. 10.4103/1319-2442.202794
20. He F, Xia X, Wu XF, Yu XQ, Huang FX. Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: A meta-analysis. Diabetologia. 2013 Mar;56:457–66. 10.1007/s00125-012-2796-6
21. Liang S, Zhang XG, Cai GY, Zhu HY, Zhou JH, Wu J, et al. Identifying parameters to distinguish non-diabetic renal diseases from diabetic nephropathy in patients with type 2 diabetes mellitus: A meta-analysis. PloS One. 2013 May 14;8(5):e64184. 10.1371/journal.pone.0064184
22. Chong YB, Keng TC, Tan LP, Ng KP, Kong WY, Wong CM, et al. Clinical predictors of non-diabetic renal disease and role of renal biopsy in diabetic patients with renal involvement: A single centre review. Renal Fail. 2012 Apr 1;34(3):323–8. 10.3109/0886022X.2011.647302
23. Zhou J, Chen X, Xie Y, Li J, Yamanaka N, Tong X. A differential diagnostic model of diabetic nephropathy and non-diabetic renal diseases. Nephrol Dial Transplant. 2008 Jun 1;23(6):1940–5. 10.1093/ndt/gfm897
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