Is there a need for changes in renal biopsy criteria in proteinuria in type 2 diabetes?

Serra, Assumpta; Romero, R.; Bayés, Beatriz; López, Dolores; Bonet, Josep

doi:10.1016/s0168-8227(02)00131-6

Cited by 53 publications

(34 citation statements)

References 15 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2012

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Aims/hypothesis The aim of this meta-analysis is to determine the predictive value of diabetic retinopathy in differentiating diabetic nephropathy from non-diabetic renal diseases in patients with type 2 diabetes and renal disease. Methods Medline and Embase databases were searched from inception to February 2012. Renal biopsy studies of participants with type 2 diabetes were included if they contained data with measurements of diabetic retinopathy. Pooled sensitivity, specificity, positive predictive value, negative predictive value and other diagnostic indices were evaluated using a random-effects model. Results The meta-analysis investigated 26 papers with 2012 patients. The pooled sensitivity and specificity of diabetic retinopathy to predict diabetic nephropathy were 0.65 (95% CI 0.62, 0.68) and 0.75 (95% CI 0.73, 0.78), respectively. The pooled positive and negative predictive value of diabetic retinopathy to predict diabetic nephropathy were 0.72 (95% CI 0.68, 0.75) and 0.69 (95% CI 0.67, 0.72), respectively. The area under the summary receiver operating characteristic curve was 0.75, and the diagnostic odds ratio was 5.67 (95% CI 3.45, 9.34). For proliferative diabetic retinopathy, the pooled sensitivity was 0.25 (95% CI 0.16, 0.35), while the specificity was 0.98 (95% CI 0.92, 1

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Section: Resultsmentioning

confidence: 99%

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

et al. 2012

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“…The strong association between retinopathy and DN was reported in many other studies. 9,17,18,20,21,23 In contrast, several studies report that diabetic patients without retinopathy may have diabetic glomerulopathy or nephropathy at a rate of 44-70%, 15,[24][25][26] indicating that the possibility of DN cannot be excluded confidently by the absence of diabetic retinopathy, although the absence of retinopathy strongly favors NDRD.…”

Section: Discussionmentioning

confidence: 99%

Clinical Predictors of Non-diabetic Renal Disease and Role of Renal Biopsy in Diabetic Patients with Renal Involvement: A Single Centre Review

et al. 2012

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Background: Type 2 diabetes mellitus (T2DM) is reportedly the leading cause of end-stage renal disease (ESRD) worldwide. However, non-diabetic renal diseases (NDRD) are not uncommon among T2DM patients with renal involvement. Our study aimed to examine the prevalence of NDRD in T2DM and clinical markers for diabetic nephropathy (DN) and NDRD and to determine the role of renal biopsy in T2DM patients and its impact on clinical practice. Methods: We conducted a retrospective analysis of T2DM patients in whom renal biopsies were performed from January 2004 to March 2008 (n = 110). Results: Biopsy results were divided into three groups: group I/pure DN (62.7%), group II/isolated NDRD (18.2%), and group III/mixed lesions (19.1%). The causes of NDRD in decreasing order of frequency were acute interstitial nephritis, glomerulonephritides, hypertensive renal disease, and acute tubular necrosis. Significant clinical markers for DN are presence of diabetic retinopathy and longer duration of diabetes. For NDRD, useful clinical markers include the presence of acute renal failure and microscopic hematuria. In the DN subgroup, Indians had significantly shorter duration of diabetes on biopsy compared with Malays and Chinese. Conclusions: NDRD is prevalent in T2DM patients, and given its potentially treatable nature, renal biopsy should be considered in T2DM patients with nephropathy, especially in those with atypical features.

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“…Les critères de suspicion de NND chez le diabétique de type 1 sont : l'hématurie microscopique, l'absence de RD, l'insuffisance rénale d'évolution rapide ou la présence d'anomalies immunologiques. Cependant ces critères ne sont pas validés chez le diabétique de type 2 [3].…”

Section: Discussionunclassified

“…La néphropathie diabétique (ND) est la première cause d'insuffisance rénale chronique terminale dans le monde [1] ; elle complique le diabète dans 40 % des cas avec une ancienneté de diabète de plus de 20 ans [2,3]. Généralement, le diagnostic de la ND est aisé si le diabète est ancien, en présence de complications dégénératives et lorsque l'évolution est marquée par une protéinurie précédant l'insuffisance rénale.…”

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La néphropathie non diabétique chez les patients diabétiques de type 2 à l’hôpital militaire Mohammed V de Rabat (Maroc)

Zajjari¹,

Benyahia²,

Ibrahim³

et al. 2012

East Mediterr Health J

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RÉSUMÉ La distinction entre les lésions de néphropathie diabétique et les lésions de néphropathie non diabétique n'est pas toujours évidente ; elle est basée souvent sur la ponction-biopsie rénale. Cette étude a évalué la prévalence et les facteurs prédictifs de la néphropathie non diabétique chez le diabétique de type 2. L'étude, réalisée entre janvier 2008 et octobre 2010 au service de néphrologie de l'hôpital militaire de Rabat, incluait 16 diabétiques de type 2 ayant bénéficié d'une ponction-biopsie rénale. La néphropathie non diabétique a été observée chez 6 patients (37,5 %) ; la néphropathie à IgA était la plus fréquente (50 % des néphropathies non diabétiques). L'hypertension artérielle était significativement moins fréquente dans le groupe de la néphropathie non diabétique que dans le groupe de la néphropathie diabétique (16,7 % contre 80,0 % ; p = 0,024), la durée du diabète était plus courte (4,5 contre 15,5 ans ; p = 0,022) et la rétinopathie diabétique absente (100 % contre 40 % ; p = 0,026). Il n'y avait pas de différence statistiquement significative entre les deux groupes en ce qui concerne l'âge, le sexe, la créatininémie, la protéinurie des 24 h, le syndrome néphrotique et l'hématurie microscopique. ABSTRACT The distinction between diabetic nephropathy lesions and non-diabetic renal lesions is not always obvious and is often based on renal biopsy. This study evaluated the prevalence and predictors of nondiabetic renal disease in people with type 2 diabetes. The study was conducted between January 2008 and October 2010 in the nephrology department of the military hospital in Rabat. The study included 16 patients with type 2 diabetes in whom renal biopsy was indicated. Non-diabetic renal disease was found in 6 of the patients (37.5%); IgA nephropathy was the most frequent non-diabetic renal disease (half of non-diabetic renal diseases). Hypertension was significantly less frequent in the non-diabetic renal disease group than the diabetic nephropathy group (16.7% versus 80.0%, P = 0024), duration of diabetes was a shorter (4.5 versus 15.5 years, P = 0.022) and diabetic retinopathy was absent (100% versus 40%, P = 0.026). There were no statistically significant differences between the 2 groups in relation to age, sex, creatinine level, 24-hour proteinuria, nephrotic syndrome and microscopic haematuria.‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫عرش‬ ‫الثامن‬ ‫املجلد‬ ‫السادس‬ ‫العدد‬ 621

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Is there a need for changes in renal biopsy criteria in proteinuria in type 2 diabetes?

Cited by 53 publications

References 15 publications

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

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

Clinical Predictors of Non-diabetic Renal Disease and Role of Renal Biopsy in Diabetic Patients with Renal Involvement: A Single Centre Review

La néphropathie non diabétique chez les patients diabétiques de type 2 à l’hôpital militaire Mohammed V de Rabat (Maroc)

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