Background: the occurrences of diabetes mellitus and diabetic nephropathy have increased quickly in the past few decades and have become an economic burden to the healthcare system in KSA. Diabetic nephropathy is a major complication of diabetes mellitus and is a primary cause of end-stage renal disease (ESRD). The occurrence of non-diabetic renal disease (NDRD) in diabetic patients has been increasingly recognized in recent years. It is generally believed that it is difficult to reverse diabetic nephropathy, whereas some cases of non-diabetic renal disease are readily treatable and remittable. However, diabetic nephropathy is known to co-exist with non-diabetic renal disease in a poorly defined population of patients with type 2 diabetes mellitus. This study estimated the pervasiveness of co-existing diabetic nephropathy and nondiabetic renal disease in Saudi patients. Methods:data were retrospectively analyzed from 122 patients with type 2 diabetes mellitus who had experienced a renal biopsy between February 2014 and June 2017 at King Abdulaziz Hospital, region(s), KSA. Male patients numbered 75 (61.5%) of the study population. The biopsies were performed as urinary abnormalities or renal functions were atypical of a diagnosis of diabetic nephropathy. Biopsy samples were examined using light, immunofluorescence (IF) and electron microscopy (EM). Clinical parameters were recorded for each patient at the time of biopsy. Results: nineteen of 122 diabetic patients (8%) had co-existing diabetic nephropathy and non-diabetic renal disease. These patients showed clinical features and pathologic characteristics of diabetic nephropathy, containing a high prevalence of diabetic retinopathy (88.8%), a long duration of diabetes, increased thickness of the glomerular basement membrane (GBM) and mesangial expansion. Nonetheless, they similarly presented with clinical findings which were inconsistent with diabetic nephropathy, such as hematuria, rapidly progressive renal failure and marked proteinuria. Immunoglobulin A (IgA) nephropathy was apparent in 5 out of the 10 patients (50%), tubulointerstitial lesions were found in two patients (20%), membranoproliferative glomerulonephritis (MPGN) in two patients (20%) and membranous nephropathy (MN) in one patients (10%). Conclusion: retrospective analysis of biopsy data suggests that approximately 8% of Saudi patients with type 2 diabetes mellitus may have co-existing diabetic nephropathy and non-diabetic renal disease. The most common histological diagnosis in our small series was IgA nephropathy.
Establishing a proper diagnosis and identifying the underlying etiology of optic neuritis can be challenging in clinical settings. This is due to the various subtypes and etiologies that were reported for the condition. However, conducting a thorough examination and the laboratory and imaging modalities can significantly enhance the diagnosis. Therefore, it is essential to be adequately aware of the different subtypes of optic neuritis and distinguish between the different clinical features and diagnostic findings of each subtype to conduct a proper diagnosis and enhance management of the affected cases. Optic neuritis is a severe condition that can lead to permanent vision loss. In the present literature review, we have discussed the potential clinical features and diagnostic findings of the different types of optic neuritis. More severe cases of optic neuritis are usually associated with NMOSD and IgG-MOG cases with a worsened prognosis. Painless and chronic vision loss might occur secondary to infections and granulomatous diseases. On the other hand, optic neuritis secondary to multiple sclerosis is usually self-limited. Many of the cases of optic neuritis are characterized by being responsive to steroid therapy. However, acute vision loss was also reported in some cases. Therefore, clinicians must be knowledgeable enough to conduct the most appropriate diagnostic and management modalities to enhance the prognosis of the affected patients. Further research is needed for optimizing the treatment plan and drawing better interventions.
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