Non-Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus-11-Year Experience from a Single Center

Abstract

Introduction: In patients with diabetes mellitus (DM), non-diabetic renal disease (NDRD) can also occurs, as well as diabetic nephropathy. NDRD is most accurately diagnosed using kidney biopsy. Aim: The aim of the study was to investigate the incidence and type of NDRD diagnosed by kidney biopsy in patients with type 2 DM and the correlation of clinical and laboratory findings with histopathological diagnosis. Material and Methods: From April 2007 to October 2018, 290 kidney biopsies were performed at the Department of Nephrology, Internal Medicine Clinic in Banja Luka, out of which 18 patients (males 9, mean age 59.8 years) were with type 2 DM. The US-guided (ultrasound device: Toshiba Famio 5) kidney biopsy was performed using an automatic biopsy instrument FAST-GUN® with needle 16G. Kidney tissue samples were analyzed by light microscopy and immunofluorescence. Results: In 18 patients with type 2 DM, the average duration of the disease was 5.9 years, 5 patients had a retinopathy, and 16 patients had hypertension. Biopsy indications were: nephrotic syndrome in 11 patients, asymptomatic urinary abnormalities in 3 patients, and rapid chronic renal failure progression. Unsatisfactory quality sample for pathohistological analysis was obtained in one patient, and out of the other 17, 6 (35.3%) had NDRD, 3 (17.6%) had NDRD superimposed with the diabetic nephropathy, and 8 (47.1%) had diabetic nephropathy. Of the patients who had NDRD, 3 had membranous glomerulonephritis, 1 had focal segmental glomerulosclerosis, and two had hypertensive nephroangiosclerosis. Out of patients with coexisting NDRD and diabetic nephropathy, 2 had hypertensive nephroangiosclerosis and one diabetic nephropathy and lupus nephritis. Conclusion: NDRD was diagnosed using kidney biopsy in 9/17 patients with type 2 DM, which confirms the significance of the kidney biopsy in patients with DM with properly indications. Accurate diagnosis provides disease specific treatment and thus significantly improves the long-term prognosis of the patient.

Nephrotic syndrome in the course of type 1 diabetes mellitus and systemic lupus erythematosus with secondary antiphospholipid syndrome – diagnostic and therapeutic problems. A case-based review

“…In the group of metabolic diseases, the most common cause of NS is diabetes, especially long-term and poorly controlled. Many studies show the co-morbidity of diabetes and kidney disease, which is not a consequence of diabetes but another associated disease [14][15][16][17]. Both SLE and diabetes can lead to the development of NS and ESRD in a variety of mechanisms.…”

“…Only intensive immunosuppressive treatment with cyclophosphamide made it possible to achieve NS remission, which was maintained by introducing MMF in longlasting treatment. Performing kidney biopsies in patients with nephropathy and diabetes should be considered particularly in patients with a short duration of diabetes, presence of hematuria, NS, or another systemic disease [2,[14][15][16][17].…”

Diagnostic value of VDBP and miR‑155‑5p in diabetic nephropathy and the correlation with urinary microalbumin

“…Clinically, the early symptoms of DN onset are not obvious, and the indicator changes are usually not obvious in routine detection, therefore difficult to detect. However, in the late stage, the disease progresses very quickly, and the liver and kidney functions also decline rapidly, which will also lead to poor prognosis due to lack of timely treatment ( 3 , 4 ). Therefore, for DN patients, early diagnosis and timely treatment have important clinical significance.…”

Urinary Exosomal MicroRNA Signatures in Nephrotic, Biopsy-Proven Diabetic Nephropathy

“…Nephrotic-range proteinuria is the most severe form of proteinuria in diabetic patients. It may result from isolated diabetic nephropathy (DN), non-diabetic renal disease, or combined nephropathies [10][11][12]. Renal biopsy is currently the only diagnostic tool able to delineate the renal pathologies in diabetic patients [12].…”

“…It may result from isolated diabetic nephropathy (DN), non-diabetic renal disease, or combined nephropathies [10][11][12]. Renal biopsy is currently the only diagnostic tool able to delineate the renal pathologies in diabetic patients [12]. However, the invasiveness and cost of this technique, as well as the risk of tissue-sampling errors limit its general applicability to the diabetes patient population [13,14].…”