Non-diabetic renal disease in Croatian patients with type 2 diabetes mellitus

https://doi.org/10.1016/j.diabres.2014.03.016Get rights and content

Abstract

Aim

Our study aimed to examine the prevalence of non-diabetic renal disease in selected patients with type 2 diabetes mellitus and to determine important risk factors for non-diabetic renal disease.

Methods

We conducted retrospective analysis of clinical, laboratory and pathohistological data of type 2 diabetes mellitus patients in whom renal biopsies were performed from January 2004 to February 2013 at Dubrava University Hospital Zagreb Croatia (n = 80).

Results

According to renal biopsy findings, isolated diabetic nephropathy was found in 46.25%, non-diabetic renal disease superimposed on diabetic nephropathy in 17.5% and isolated non-diabetic renal disease in 36.25% of the patients. The most common non-diabetic renal diseases found were: membranous nephropathy, followed by IgA nephropathy and focal segmental glomerulosclerosis. In univariate analysis shorter duration of diabetes, independence of insulin therapy, lower levels of HbA1c and absence of diabetic retinopathy were found to be significant clinical predictors of non-diabetic renal disease. In multivariate analysis only independence of insulin therapy (OR 4.418, 95%CI = 1.477–13.216) and absence of diabetic retinopathy (OR 5.579, 95%CI = 1.788–17.404) were independent predictors of non-diabetic renal disease.

Conclusions

This study confirmed usefulness of renal biopsy in patients with type 2 diabetes mellitus, due to the high prevalence of non-diabetic renal disease found. Since non-diabetic renal disease are potentially curable, we should consider renal biopsy in selected type 2 diabetes mellitus patients with renal involvement, especially in those with absence of diabetic retinopathy and independence of insulin therapy.

Introduction

The incidence and prevalence of type 2 diabetes mellitus (T2DM) are increasing and becoming one of the major health care problems in the world [1], [2]. Diabetic nephropathy (DN) is one of the major complications of diabetes mellitus and is reported as the leading cause of the end-stage renal disease (ESRD) worldwide [1], [3]. The diagnosis of DN is mostly clinical, based on duration of T2DM and the presence of retinopathy, neuropathy and other chronic complications, proteinuria and slowly progressing azothemia. This kind of diagnostic approach has been constantly challenged, due to the fact that other non-diabetic renal diseases (NDRD) have been found in T2DM patients. The prevalence of other biopsy-proven glomerular, tubulointerstitial and/or vascular diseases in T2DM in reported studies [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27] varies considerably, ranging from 8% [4] to 93.5% [5]. This depends on the selection criteria, indications and availability of renal biopsy as well as on the population investigated. Despite the fact that NDRD in selected T2DM patients is not uncommon and renal biopsy is the only tool to absolutely identify DN or NDRD, the role of renal biopsy in T2DM patients with signs and symptoms of renal disease remains controversial. The findings of NDRD could have major therapeutic and prognostic implications, since the majority of glomerular and tubulointerstitial diseases are treatable, even remittable, which is quite different from DN. This is supported by the results of a recent study, which showed that the patients with NDRD have significantly better renal outcomes compared to patients with DN only [7]. The results of previous studies on discriminatory factors between DN and NDRD are not uniform, and there are differences in study populations and selection criteria [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27]. The purpose of this study was to evaluate the indications of renal biopsy and to determine predictors of NDRD and DN in Croatian patients with T2DM referred to our center. In our center the majority of adult native renal biopsies in Croatia are performed, and our results were recently published [28].

Section snippets

Patients and methods

The present study was conducted by reviewing the medical records of T2DM patients who underwent percutaneous renal biopsy in Dubrava University Hospital, Zagreb, Croatia from January 2004 to February 2013. All patients were diagnosed at the time of biopsy with T2DM as defined by the WHO, ADA and EDA [1], [29], [30]. Biopsy indications were uniform throughout the study period and were based on clinically strong suspicion of NDRD and included one or more of the following factors: heavy

Results

80 patients with T2DM were included in this study. Mean age at biopsy was 59.5 ± 9.8 years, 70% of patients were male and median duration of diabetes was 10 years (ranging from 0 – i.e. newly diagnosed disease – to 39 years). The baseline clinical and laboratory data collected are shown in Table 1.

The most common indication for renal biopsy was nephrotic syndrome (80%) and in 75% of patients there was renal failure (acute, rapidly progressive or unexplained chronic). In 43 patients NDRD was found

Discussion

Diabetic nephropathy is the most common cause of ESRD worldwide [1], [3], while diagnosis of DN is frequently based on clinical criteria exclusively and patients with potential NDRD are often overlooked. Comparison of clinical diagnostic criteria and histologic findings of DN is usually not directly tested in recent studies [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], as well as in our study. This is

Conflict of interest statement

None.

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