Presence of Non-Diabetic Kidney Diseases in Biopsy Specimens of Diabetic Patients’ Single Center Experience
Abstract
:1. Introduction
2. Results
3. Discussion
4. Methods and Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Diabetes. Available online: https://www.who.int/health-topics/diabetes (accessed on 30 July 2023).
- Alicic, R.Z.; Rooney, M.T.; Tuttle, K.R. Diabetic kidney disease: Challenges, progress, and possibilities. Clin. J. Am. SocNephrol. 2017, 12, 2032–2045. [Google Scholar] [CrossRef]
- Fioretto, P.; Caramori, M.L.; Mauer, M. The kidney in diabetes: Dynamic pathways of injury and repair. The Camillo Golgi Lecture 2007. Diabetologia 2008, 51, 1347–1355. [Google Scholar] [CrossRef]
- Martínez-Castelao, A.; Navarro-González, J.; Górriz, J.; de Alvaro, F. The concept and the epidemiology of diabetic nephropathy have changed in recent years. J. Clin. Med. 2015, 4, 1207–1216. [Google Scholar] [CrossRef] [PubMed]
- Selby, N.M.; Taal, M.W. An updated overview of diabetic nephropathy: Diagnosis, prognosis, treatment goals and latest guidelines. Diabetes Obes. Metab. 2020, 22 (Suppl. S1), 3–15. [Google Scholar] [CrossRef]
- Ali, M.K.; Bullard, K.M.; Saydah, S.; Imperatore, G.; Gregg, E.W. Cardiovascular and renal burdens of rediabetes in the USA: Analysis of data from serial cross-sectional surveys, 1988–2014. Lancet Diabetes Endocrinol. 2018, 6, 392–403. [Google Scholar] [CrossRef] [PubMed]
- He, F.; Xia, X.; Wu, X.F.; Yu, X.Q.; Huang, F.X. Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: A meta-analysis. Diabetologia 2013, 56, 457–466. [Google Scholar] [CrossRef]
- Selby, N.M.; Taal, M.W. Long-term outcomes after AKI—A major unmet clinical need. Kidney Int. 2019, 95, 21–23. [Google Scholar] [CrossRef] [PubMed]
- See, E.J.; Jayasinghe, K.; Glassford, N.; Bailey, M.; Johnson, D.W.; Polkinghorne, K.R.; Toussaint, N.D.; Bellomo, R. Long-term risk of adverse outcomes after acute kidney injury: A systematic review and metaanalysis of cohort studies using consensus definitions of exposure. Kidney Int. 2019, 95, 160–172. [Google Scholar] [CrossRef] [PubMed]
- Jiang, S.; Wang, Y.; Zhang, Z.; Dai, P.; Yang, Y.; Li, W. Accuracy of hematuria for predicting non-diabetic renal disease in patients with diabetes and kidney disease: A systematic review and meta-analysis. Diabetes Res. Clin. Pract. 2018, 143, 288–300. [Google Scholar] [CrossRef] [PubMed]
- Tong, X.; Yu, Q.; Ankawi, G.; Pang, B.; Yang, B.; Yang, H. Insights into the Role of Renal Biopsy in Patients with T2DM: A Literature Review of Global Renal Biopsy Results. Diabetes Ther. 2020, 11, 1983–1999. [Google Scholar] [CrossRef] [PubMed]
- Horvatic, I.; Tisljar, M.; Kacinari, P.; Matesic, I.; Bulimbasic, S.; Ljubanovic, D.G.; Katic, T.; Kristovic, D.; Galesic, K. Non-diabetic renal disease in Croatian patients with Type 2 diabetes mellitus. Diabetes Res. Clin. Pract. 2014, 104, 443–450. [Google Scholar] [CrossRef]
- Grujicic, M.; Salapura, A.; Basta-Jovanovic, G.; Figurek, A.; Micic-Zrnic, D.; Grbic, A. Non-diabetic kidney disease in patients with type 2 diabetes mellitus—11-year experience from a single center. Med. Arch. 2019, 73, 87–91. [Google Scholar] [CrossRef]
- Rychlík, I.; Jančová, E.; Tesař, V.; Kolský, A.; Lácha, J.; Stejskal, J.; Stejskalová, A.; Dušek, J.; Herout, V. The Czech registry of renal iopsies. Occurrence of renal diseases in the years 1994–2000. Nephrol. Dial. Transpl. 2004, 19, 3040–3049. [Google Scholar] [CrossRef] [PubMed]
- Prakash, J.; Lodha, M.; Singh, S.K.; Vohra, R.; Raja, R. Diabetic retinopathy is a poor predictor of type of nephropathy in proteinuric type 2 diabetic patients. J. Assoc. Physicians India 2007, 55, 412–416. [Google Scholar] [PubMed]
- Zhuo, L.; Ren, W.; Li, W.; Zou, G.; Lu, J. Evaluation of renal biopsies in type 2 diabetic patients with kidney disease: A clinicopathological study of 216 cases. Int. Urol. Nephrol. 2013, 45, 173–179. [Google Scholar] [CrossRef]
- Sharma, S.G.; Bomback, A.S.; Radhakrishnan, J.; Herlitz, L.C.; Stokes, M.B.; Markowitz, G.S.; D’Agati, V.D. The modern spectrum of renal biopsy findings in patients with diabetes. Clin. J. Am. Soc. Nephrol. 2013, 8, 1718–1724. [Google Scholar] [CrossRef]
- 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, 23, 1940–1945. [Google Scholar] [CrossRef] [PubMed]
- Singh, S.; Shankar Patel, P.; Archana, A. Heterogeneity in Kidney Histology and Its Clinical Indicators in Type 2 Diabetes Mellitus: A Retrospective Study. J. Clin. Med. 2023, 12, 1778. [Google Scholar] [CrossRef]
- Comai, G.; Malvi, D.; Angeletti, A.; Vasuri, F.; Valente, S.; Ambrosi, F.; Capelli, I.; Ravaioli, M.; Pasquinelli, G.; D’Errico, A.; et al. Histological Evidence of Diabetic Kidney Disease Precede Clinical Diagnosis. Am. J. Nephrol. 2019, 50, 29–36. [Google Scholar] [CrossRef]
- Arques, S. Human serum albumin in cardiovascular diseases. Eur. J. Intern. Med. 2018, 52, 8–12. [Google Scholar] [CrossRef]
- Dong, Z.; Wang, Y.; Qiu, Q.; Zhang, X.; Zhang, L.; Wu, J.; Wei, R.; Zhu, H.; Cai, G.; Sun, X.; et al. Clinical predictors differentiating non-diabetic renal diseases from diabetic nephropathy in a large population of type 2 diabetes patients. Diabetes Res. Clin. Pract. 2016, 121, 112–118. [Google Scholar] [CrossRef]
- Tone, A.; Shikata, K.; Matsuda, M.; Usui, H.; Okada, S.; Ogawa, D.; Wada, J.; Makino, H. Clinical features of non-diabetic renal diseases in patients with type 2 diabetes. Diabetes Res. Clin. Pract. 2005, 69, 237–242. [Google Scholar] [CrossRef]
- Wang, X.; Li, J.; Huo, L.; Feng, Y.; Ren, L.; Yao, X.; Jiang, H.; Lv, R.; Zhu, M.; Chen, J. Clinical characteristics of diabetic nephropathy in patients with type 2 diabetic mellitus manifesting heavy proteinuria: A retrospective analysis of 220 cases. Diabetes Res. Clin. Pract. 2019, 157, 107874. [Google Scholar] [CrossRef]
- Castellano, I.; Covarsí, A.; Novillo, R.; Gómez-Martino, J.R.; Ferrando, L. Renal histological lesions in patients with type II diabetes mellitus. Nefrologia 2002, 22, 162–169. [Google Scholar]
- Liang, S.; Zhang, X.G.; Cai, G.Y.; Zhu, H.Y.; Zhou, J.H.; Wu, J.; Chen, P.; Lin, S.P.; Qiu, Q.; Chen, X.M. Identifying parameters to distinguish non-diabetic renal diseases from diabetic nephropathy in patients with type 2 diabetes mellitus: A meta-analysis. PLoS ONE 2013, 8, e64184. [Google Scholar] [CrossRef]
- Shimizu, M.; Furuichi, K.; Toyama, T.; Kitajima, S.; Hara, A.; Kitagawa, K.; Iwata, Y.; Sakai, N.; Takamura, T.; Yoshimura, M.; et al. Long-Term outcomes of Japanese type 2 diabetic patients with biopsy-proven diabetic nephropathy. Diabetes Care 2013, 36, 3655–3662. [Google Scholar] [CrossRef] [PubMed]
- Okada, S.; Samejima, K.I.; Matsui, M.; Morimoto, K.; Furuyama, R.; Tanabe, K.; Eriguchi, M.; Akai, Y.; Saito, Y.; Tsuruya, K. Microscopic hematuria is a risk factor for end-stage kidney disease in patients with biopsy-proven diabetic nephropathy. BMJ Open. Diabetes Res. Care 2020, 8, e001863. [Google Scholar] [CrossRef]
- Alsaad, K.O.; Hezenberg, A.M. Distinguishing diabetic nephropathy from other causes of glomerulosclerosis: An update. J. Clin. Pathol. 2007, 60, 18–26. [Google Scholar] [CrossRef]
- Hiller, A.; Greif, R.L.; Beckman, W.W. Determination of protein in urine by the biuret method. J. Biol. Chem. 1948, 176, 1421–1429. [Google Scholar] [CrossRef] [PubMed]
Patients with DM (No = 74) | |
---|---|
Gender (M/F) | 50/24 (68%/32%) |
Age (years) | 58 ± 11 (min 22–max 84) |
DM duration (years) | 6.3 ± 5.9 (min 1–max 27) |
HbA1c (%) | 6.45 ± 1.28 (min 5.1–max 11.1) |
DM therapy at the moment of biopsy: | |
Insulin therapy | 26 (35%) |
Oral antidiabetics | 32 (43%) |
Hygienic-dietery regimen | 13 (18%) |
Insulin and oral antidiabetics | 3 (4%) |
Indication for renal biopsy: | |
Nephrotic syndrome | 23 (31%) |
Proteinuria | 16 (22%) |
Worsening of kidney function and proteinuria | 22 (30%) |
Suspicion on SAD | 13 (17%) |
Retinopathy (yes/no/NA) | 30/14/30 (40.5%/19%/40.5%) |
Haematuria (yes/no) | 55/19 (74%/26%) |
Albuminaemia (g/L) | 30 ± 9 (min 13–max 48) |
Proteinaemia (g/L) | 64 ± 10 (min 40–max 81) |
Quantitative proteinuria (gr/24 h) | 8.4 ± 5.5(min 0.10–max 25.00) |
Cholesterol (mmol/L) | 5.8 ± 2.1 (min 2.6–max 13.0) |
Thrygliceride (mmol/L) | 2.6 ± 1.4 (min–max) |
Creatinine (mcmol/L) | 222 ± 188 (min 54–max 1246) |
Non-DN Group No = 32 | Mixed Group (DN + Non-DN), No = 11 | |
---|---|---|
MesPGN | 9 (28.1%) | 1 (9%) |
MN | 6 (18.6%) | 4 (36%) |
FSGS | 3 (9.4%) | 3 (28%) |
RPGN | 2 (6.2%) | / |
MCD | 1 (3.2%) | / |
MPGN | 1 (3.2%) | 1 (9%) |
amyloidosis | 1 (3.2%) | / |
other | 9 (28.1%) | 2 (18%) |
DN Group | Non-DN Group | Mixed Group (DN + Non-DN) | p * | |
---|---|---|---|---|
No(%) of patients | 31 (42) | 32 (43) | 11 (15) | |
Gender (M/F) | 20/11 | 22/10 | 8/3 | 0.867 |
Age (years) | 57 ± 14 | 60 ± 7 | 57 ± 12 | 0.401 |
HbA1c (%) | 6.83 ± 1.60 | 6.29 ± 0.95 | 5.88 ± 0.84 | 0.078 |
DM therapy at the moment of biopsy: | ||||
Insulin therapy | 15 (48%) | 9 (28%) | 2 (18%) | 0.011 |
Oral antidiabetics | 7 (23%) | 16 (50%) | 9 (72%) | |
Hygienic-dietery regimen | 6 (19%) | 7 (22%) | 0 | |
Insulin and oral antidiabetics | 3 (10%) | 0 | 0 | |
Indication for renal biopsy: | ||||
Nephrotic syndrome | 8 (26%) | 10 (31%) | 5 (46%) | 0.815 |
proteinuria | 6 (19%) | 8 (25%) | 2 (18%) | |
Worsening of kidney function and proteinuria | 12 (39%) | 8 (25%) | 2 (18%) | |
Suspicion on SAD | 5 (16%) | 6 (19%) | 2 (18%) | |
DM duration (years) | 5.7 ± 6.0 | 7.7 ± 6.2 | 4.1 ± 2.8 | 0.142 |
Retinopathy (yes/no/NA) | (11/9/11) | (3/14/15) | (0/7/4) | 0.024 |
Haematuria (yes/no) | 23/8 | 23/9 | 9/2 | 0.809 |
Albuminaemia (g/L) | 29 ± 7 | 31 ± 9 | 32 ± 10 | 0.754 |
Proteinaemia (g/L) | 61 ± 8 | 65 ± 11 | 63 ± 13 | 0.388 |
24 h proteinuria (gr/24h) | 9.15 ± 4.93 | 7.01 ± 5.35 | 10.15 ± 6.72 | 0.112 |
Cholesterol (mmol/L) | 5.7 ± 2.1 | 5.6 ± 1.9 | 6.6 ± 2.6 | 0.399 |
Triglyceride (mmol/L) | 2.3 ± 1.2 | 2.6 ± 1.0 | 3.5 ± 2.4 | 0.244 |
Creatinine (mcmol/L) | 238 ± 160 | 223 ± 226 | 178 ± 139 | 0.412 |
p | OR | 95% CI | |
---|---|---|---|
24-h proteinuria | 0.013 | 0.705 | 0.534–0.930 |
Proteinaemia | 0.035 | 1.114 | 1.008–1.231 |
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Janković, A.; Dimković, N.; Todorov-Sakić, V.; Bulatović, A.; Simović, N.; Đurić, P.; Naumović, R. Presence of Non-Diabetic Kidney Diseases in Biopsy Specimens of Diabetic Patients’ Single Center Experience. Int. J. Mol. Sci. 2023, 24, 14759. https://0-doi-org.brum.beds.ac.uk/10.3390/ijms241914759
Janković A, Dimković N, Todorov-Sakić V, Bulatović A, Simović N, Đurić P, Naumović R. Presence of Non-Diabetic Kidney Diseases in Biopsy Specimens of Diabetic Patients’ Single Center Experience. International Journal of Molecular Sciences. 2023; 24(19):14759. https://0-doi-org.brum.beds.ac.uk/10.3390/ijms241914759
Chicago/Turabian StyleJanković, Aleksandar, Nada Dimković, Verica Todorov-Sakić, Ana Bulatović, Nikola Simović, Petar Đurić, and Radomir Naumović. 2023. "Presence of Non-Diabetic Kidney Diseases in Biopsy Specimens of Diabetic Patients’ Single Center Experience" International Journal of Molecular Sciences 24, no. 19: 14759. https://0-doi-org.brum.beds.ac.uk/10.3390/ijms241914759