Kidney biopsy in patients with diabetes mellitus

Haider, Dominik G.; Peric, Slobodan; Friedl, Alexander; Fuhrmann, Valentin; Wolzt, Michael; Hörl, Walter H.; Soleiman, Afschin

doi:10.5414/cn106955

Cited by 31 publications

(19 citation statements)

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“…Either a high frequency of glomerulo nephritis in people with diabetes or coexistence of glomerulonephritis with diabetic glomerulosclerosis has been reported among various cohorts of non-Aboriginal patients. [29][30][31][32] In an observational study involving 567 consecutive renal biopsies in European patients with type 1 or 2 diabetes and chronic kidney disease, about 70% of patients had diabetic nephropathy and 30% had other glomerular diseases (e.g., immune complex glomerulonephritis, secondary focal glomerulosclerosis, IgA nephropathy). 30 In an Australian cohort of patients with diabetes, concomitant nondiabetic renal disease (mostly glomerulonephritis and tubulointerstitial disease) with diabetic glomerulosclerosis was found in 38 of 136 (28%) consecutive renal biopsies done primarily for proteinuria.…”

Section: Discussionmentioning

confidence: 99%

“…[29][30][31][32] In an observational study involving 567 consecutive renal biopsies in European patients with type 1 or 2 diabetes and chronic kidney disease, about 70% of patients had diabetic nephropathy and 30% had other glomerular diseases (e.g., immune complex glomerulonephritis, secondary focal glomerulosclerosis, IgA nephropathy). 30 In an Australian cohort of patients with diabetes, concomitant nondiabetic renal disease (mostly glomerulonephritis and tubulointerstitial disease) with diabetic glomerulosclerosis was found in 38 of 136 (28%) consecutive renal biopsies done primarily for proteinuria. 29 A study involving 90 children (98% First Nations or Métis) with type 2 diabetes from Manitoba also supports the possibility that diabetes is a comorbid condition.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and causes of end-stage renal disease among Aboriginal children and young adults

Samuel

Foster

Hemmelgarn

et al. 2012

CMAJ

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Background: Although Aboriginal adults have a higher risk of end-stage renal disease than non-Aboriginal adults, the incidence and causes of end-stage renal disease among Aboriginal children and young adults are not well described. Methods:We calculated age-and sex-specific incidences of end-stage renal disease among Aboriginal people less than 22 years of age using data from a national organ failure registry. Incidence rate ratios were used to compare rates between Aboriginal and white Canadians. To contrast causes of end-stage renal disease by ethnicity and age, we calculated the odds of congenital diseases, glomerulonephritis and diabetes for Aboriginal people and compared them with those for white people in the following age strata: 0 to less than 22 years, 22 to less than 40 years, 40 to less than 60 years and older than 60 years.Results: Incidence rate ratios of end-stage renal disease for Aboriginal children and young adults (age < 22 yr, v. white people) were 1.82 (95% confidence interval [CI] 1.40-2.38) for boys and 3.24 (95% CI 2.60-4.05) for girls. Compared with white people, congenital diseases were less common among Aboriginal people aged less than 22 years (odds ratio [OR] 0.56, 95% CI 0.36-0.86), and glomerulonephritis was more common (OR 2.18, 95% CI 1.55-3.07). An excess of glomerulonephritis, but not diabetes, was seen among Aboriginal people aged 22 to less than 40 years. The converse was true (higher risk of diabetes, lower risk of glomerulonephritis) among Aboriginal people aged 40 years and older. Interpretation:The incidence of end-stage renal disease is higher among Aboriginal children and young adults than among white children and young adults. This higher incidence may be driven by an increased risk of glomerulonephritis in this population. AbstractResearch CMAJ, October 2, 2012, 184 (14) E759

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence and causes of end-stage renal disease among Aboriginal children and young adults

Samuel

Foster

Hemmelgarn

et al. 2012

CMAJ

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“…All studies included patients with Type 2 diabetes. Type 1 diabetic patients represented a small percentage of the study population in six studies (ranging from 8 to 38% of participants) [12,18,32,38,40,41]. No studies reported data based only on patients with Type 1 diabetes.…”

Section: Study and Participants' Characteristicsmentioning

confidence: 99%

“…Information on serum creatinine values was available in 34 studies [6, 7, 9-11, 13, 15-17, 19-21, 23-25, 27-29, 31, 33, 34, 37, 38, 42-48, 50-53]; in 10 of these studies the majority of patients had mean serum creatinine levels falling roughly within the normal range (<1.43 mg/dL) [16, 20, 25, 28, 31, 42-44, 51, 52]. In 12 studies mean values ranged from 1.44 to 3.00 mg/dL [7,10,13,23,25,27,29,34,37,45,47,53] while the remaining 12 included patients with quite severely compromised renal function (serum creatinine >3 mg/dL) [6,9,11,12,15,19,21,24,33,38,46,50]. Data on estimated glomerular filtration rate (eGFR) were available in 16 of the above-mentioned studies reporting information on serum creatinine [7, 10, 13, 15-17, 19-21, 28, 34, 42, 48, 51-53].…”

Section: Study and Participants' Characteristicsmentioning

confidence: 99%

Renal biopsy in patients with diabetes: a pooled meta-analysis of 48 studies

Fiorentino

Bolignano²,

Tesař

et al. 2016

Nephrol. Dial. Transplant.

112

131

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Background. The utility of renal biopsy in patients with diabetes is highly debated. Diabetics with rapidly worsening renal disease are often 'clinically' labelled as having diabetic nephropathy (DN), whereas, in many cases, they are rather developing a nondiabetic renal disease (NDRD) or mixed forms (DN þ NDRD). Methods. We performed a systematic search for studies on patients with diabetes with data on the frequency of DN, NDRD and mixed forms, and assessed the positive predictive values (PPVs) and odds ratios (ORs) for such diagnoses by metaanalysing single-study prevalence. Possible factors explaining heterogeneity among the different diagnoses were explored by meta-regression. Results. In the 48 included studies (n ¼ 4876), the prevalence of DN, NDRD and mixed forms ranged from 6.5 to 94%, 3 to 82.9% and 4 to 45.5% of the overall diagnoses, respectively. IgA nephropathy was the most common NDRD (3-59%). PPVs for DN, NDRD and mixed forms were 50.1% [95% confidence interval (CI): 44.7-55.2], 36.9% (95% CI: 32.3-41.8) and 19.7% (95% CI: 16.3-23.6), respectively. The PPV when combining NDRD and mixed forms was 49.2% (95% CI: 43.8-54.5). Metaregression identified systolic pressure, HbA1c, diabetes duration and retinopathy as factors explaining heterogeneity for NDRD, creatinine and glomerular filtration rate for mixed forms and only serum creatinine for DN. ORs of DN versus NDRD and mixed forms were 1.71 (95% CI: 1.54-1.91) and 4.1 (95% CI: 3.43-4.80), respectively. Conclusions. NDRD are highly prevalent in patients with diabetes. Clinical judgment alone can lead to wrong diagnoses and delay the establishment of adequate therapies. Risk stratification according to individual factors is needed for selecting patients who might benefit from biopsy.

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“…5,6 Given these issues and others, it also does not serve well as a surrogate end point for progression of diabetic kidney disease. 7,8 Although creatinine and other indicators of GFR such as cystatin C are prognostic biomarkers of a sort, their insensitivity and unreliability as early indicators of progressive diabetic kidney disease, and CKD in general, have been bemoaned for decades. Unfortunately, despite great interest and effort, no sensitive and specific prognostic biomarkers or surrogate end points for progressive diabetic nephropathy have been validated.…”

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confidence: 99%