Non-diabetic renal disease in Croatian patients with type 2 diabetes mellitus
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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Cited by (32)
Criteria to indicate kidney biopsy in type 2 diabetic patients with proteinuria: Survey among French nephrologists
2019, Nephrologie et TherapeutiqueClinical characteristics of diabetic nephropathy in patients with type 2 diabetic mellitus manifesting heavy proteinuria: A retrospective analysis of 220 cases
2019, Diabetes Research and Clinical PracticeCitation Excerpt :The proportion of DN in patients with diabetic renal disease reportedly ranges from 8% to 94% [7–11]. Moreover, NDRD was identified in 50.46% of biopsies: 94 patients with NDRD alone and 17 with DN plus NDRD, which are most similar to another report [12]. The prevalence of NDRD in diabetic patients with kidney involvement varies widely from 3% to 82.9% [8,12,13].
Accuracy of hematuria for predicting non-diabetic renal disease in patients with diabetes and kidney disease: A systematic review and meta-analysis
2018, Diabetes Research and Clinical PracticeCitation Excerpt :Twenty-nine studies had a retrospective design [3,4,7,9–11,19–24,26–42], and six had a prospective design [1,2,8,12,18,25]. Twenty-eight articles focused on Asian populations [2,4,7–12,18–29,34–41], three were performed in European countries [1,31,33], two in north America [3,30], one in Oceanic nation [32], and one study in African region [42]. Various criteria for both scientific research and clinical diagnoses were used to define microscopic hematuria: ≥2 RBCs per high-power field (HPF) in four studies [3,10,12,26]; ≥3 RBCs/HPF in three studies [1,27,40]; >3 RBCs/HPF in eight studies [7,28,31,35,38–41]; >3 RBCs/mm3 in one study [42]; >15 RBCs/mm3 in one study [32]; >5 RBCs/HPF in three studies [11,30,40]; ≥5 RBCs/HPF in three studies [4,29,34]; >7 RBCs/HPF in two studies [39,40]; >8 RBCs/HPF in one study [40]; >10 RBCs/HPF in two studies [39,40]; >15 RBCs/HPF in two studies [39,40]; >20 RBCs/HPF in one study [39]; >5 RBCs/μL in one study [9]; >10 RBCs/μL in five studies [18,19,22–24]; and in 8 studies no relevant details were provided [2,8,20,21,25,33,36,37].
Clinical predictors differentiating non-diabetic renal diseases from diabetic nephropathy in a large population of type 2 diabetes patients
2016, Diabetes Research and Clinical PracticeCitation Excerpt :The present study was conducted to determine the frequency of NDRDs in type 2 DM patients in China and also to identify common clinical markers associated with NDRDs in the type 2 diabetic population. Previous studies usually included patients with coexisting DN and NDRDs [12,13], probably due to limited sample sizes, but this increases systematic errors due to confounding factors. In the present study, we included only patients with either DN or a NDRD in order to evaluate the diagnostic performance of clinical markers for predicting NDRD development in type 2 DM patients.