Evaluation of Renal Biopsy Samples of Patients with Diabetic Nephropathy.

Abstract

Objective To evaluate the usefulness of renal biopsy in the overall managementof patients with diabetes mellitus (DM), we examined the relationship between the clinical parameters and histopathological findings of renal biopsy samples.MethodsRenal biopsy specimens were obtained from 109 type 2 diabetic patients with proteinuria. Samples were divided into the following two groups: Diabetic Nephropathy (DN) group (n=80) had typical diabetic lesions without other renal diseases, complication group (n=29) had diabetic lesions with other renal diseases. Furthermore, DN group was subdivided into two subgroups: slow progressive group (SP group, n=32), the level of serum creatinine (s-Cr) was normal at the time of renal biopsy and three years after renal biopsy, and fast progressive group (FP group, n=14), the level of s-Cr was normal at the time of renal biopsy but more than doubled three years after renal biopsy.Results The level of total protein was significantly lower and HbAlc significantly higher in the DNgroup than in the Complication group. However, other clinical parameters were not significantly different between the two groups. Urinary protein, systolic and diastolic blood pressure in FP group were significantly higher than in SP group. The percentage of sclerotic glomeruli, the severity of mesangial expansion, tubular injury and cell infiltration were significantly greater in FP than in SP group. Conclusions Ourresults indicated that a complete evaluation of renal pathology in DMcould not be made by clinical parameters only, and that the progression of DNcould be accurately predicted by histopathological evaluation. Therefore, this study emphasizes the importance of renal biopsy in the overall management of patients with DMand/ orDN.

Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis

“…Different methods were used to assess DR: ophthalmoscopy after mydriasis in four studies [21,22,24,30,36]; fundus photography after mydriasis in one study [27]; ophthalmoscopy without mydriasis in four studies [15,23,26,28,29,33,34,40]; and in nine studies no relevant details were provided [8, 10, 25, 31-33, 35, 38, 39]. Of the nine prospective studies assessed, five were screening studies conducted on consecutive patients with type 2 diabetes mellitus and proteinuria [21][22][23][24][25], while the remaining four were conducted on selected type 2 diabetes mellitus populations using criteria for the biopsy for type 1 diabetes mellitus (microhaematuria, absence of DR, atypical change in renal function, or immunological abnormalities) [26][27][28][29]. However, in most DR predicting DN Forest plots of the pooled sensitivity and specificity are shown in Fig.…”

“…The diamond and vertical lines/brackets represent the pooled estimate with its 95% CI specificity, positive predictive value and negative value of PDR predicting biopsy-proven DN. Only four studies evaluated DR graded as simple or proliferative DR [8,21,24,28]. The sensitivity ranged from 0.03 to 0.57 (pooled sensitivity 0.25, 95% CI 0.16, 0.35), while the specificity ranged from 0.93 to 1.00 (pooled specificity 0.98, 95% CI 0.92, 1.00).…”

“…For instance, studies included patients with microalbuminuria (20-200 mg/day) [21], macroalbuminuria with ranges defined as from >300 mg/day to >3 g/day [9, 14, 15, 22-29, 31, 34, 36-39], or not defined clearly. In addition, there was significant diversity in the methods used to assess DR, and only seven studies applied gold standards for DR screening [21,22,24,27,30,36,37,43]. A third issue was the different categories of renal pathology between studies.…”

LUPUS NEPHRITIS- A STUDY ON CLINICAL & HISTOMORPHOLOGICAL VARIABLES IN RELATION TO PROGNOSIS, IN NORTH KERALA

“…[21][22][23] We have used a similar grading system modified to suit diffuse endocapillary proliferative glomerulonephritis. We have further tried to predict those cases with adverse outcome by combining the clinical and histological parameters which differed significantly between the groups with good and poor outcomes.…”

Dual Blockade of the Renin-Angiotensin System

“…Both type 1 and 2 diabetic nephropathies are characterized by the appearance of microalbuminuria, which leads to overt proteinuria and progressive loss of GFR (18). However, a series of renal biopsies in patients with type 2 diabetes and proteinuria revealed that a significant proportion of these patients had glomerular lesions other than the classic lesions associated with type 1 diabetic nephropathy (19,20). ACE-I, which improve glomerular permeability in patients with type 1 diabetes as assessed by dextran clearances, do not do so in patients with type 2 diabetes (21).…”