Prevalence of non-diabetic renal disease in patients with type 2 diabetes

Mou, Shan; Wang, Qin; Liu, Jian; Che, Xiajing; Zhang, Minfang; Cao, Liou; Zhou, Wenyan; Ni, Zhaohui

doi:10.1016/j.diabres.2009.11.012

Cited by 76 publications

(86 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our results are an important addition to previously reported data from smaller cohorts on biopsy findings in (1,2), the majority of reports have suggested that a higher degree of proteinuria is found in DN than in NDRD (3,4,8,10,11).…”

Section: Discussionsupporting

confidence: 53%

“…The value of such serologic testing in predicting NDRD has not been reported by others (1)(2)(3)(4)8,10,11). In our cohort, although the finding of any positive serologic test performed at the time of biopsy was not predictive of NDRD, the specific findings of low complement levels (low C3 and/or low C4) and M-spike in either serum or urine, on univariate analyses, were associated with NDRD on biopsy.…”

Section: Discussioncontrasting

confidence: 45%

“…The overwhelming majority of these diagnoses would yield some change in treatment, ranging from the use of immunosuppression to titration of renin-angiotensinaldosterone system blockade. The most common NDRDs previously reported in patients with DM are IgAN (3,(11)(12)(13), FSGS (1,10), and MGN (10,14). In our series, FSGS was the most common finding in NDRD alone, identified in 48 patients (22%) and, in all but 6 patients, read as secondary or adaptive FSGS related to such comorbidities as obesity and systemic hypertension.…”

Section: Discussionmentioning

confidence: 66%

See 2 more Smart Citations

The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

Sharma

Bomback

Radhakrishnan

et al. 2013

Clinical Journal of the American Society of Nephrology

252

221

View full text Add to dashboard Cite

SummaryBackground and objectives Renal biopsies performed in diabetic patients are increasing in number and complexity. This study sought to determine the usefulness of renal biopsy in patients with diabetes and the predictability of diagnosing diabetic nephropathy (DN) versus nondiabetic renal disease (NDRD) from clinical and laboratory data.Design, setting, participants, & measurements To assess modern trends, a retrospective study was performed of clinical-pathologic findings in all patients with diabetes who had a biopsy in 2011. Among 2642 native kidney biopsies, 620 (23.5%) were from patients with diabetes.Results The cohort included 371 men (60.7%) aged a median (interquartile range) 62 years (52-69) with 10-year (5-15) duration of diabetes mellitus (DM). Median serum creatinine was 2.5 mg/dl (1.6-4.4), and 52% of patients had stage 4-5 CKD. On biopsy, 37% of patients had DN alone, 36% had NDRD alone, and 27% had DN plus NDRD. In NDRD alone, FSGS (22%), hypertensive nephrosclerosis (18%), acute tubular necrosis (ATN) (17%), IgA nephropathy (11%), membranous GN (8%), and pauci-immune GN (7%) comprised 80% of diagnoses, compared with ATN (43%), hypertensive nephrosclerosis (19%), FSGS (13%), and IgA nephropathy (7%) for DN plus NDRD. In multivariate analyses, longer duration of DM was associated with a greater likelihood of DN and a lower likelihood of NDRD: each added year of DM reduced the odds of NDRD by 5% (odds ratio, 0.95; 95% confidence interval, 0.91 to 0.98; P=0.004). DM duration $12 years was the best predictor (58% sensitivity, 73% specificity) of DN alone.Conclusions Approximately one-quarter of all renal biopsies are performed in patients with DM. Judicious use of renal biopsy has uncovered NDRD alone or superimposed on DN in the majority of such biopsies. ATN is emerging as an important category of NDRD, which has not been reported previously.

show abstract

Section: Discussionsupporting

confidence: 53%

Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 66%

See 1 more Smart Citation

The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

Sharma

Bomback

Radhakrishnan

et al. 2013

Clinical Journal of the American Society of Nephrology

252

221

View full text Add to dashboard Cite

show abstract

“…Indeed, previous literature has shown that DR may be helpful in distinguishing the type of kidney pathology in patients with type 2 diabetes mellitus and renal disease [13][14][15]. However, the results of these studies are diverse and have been found to have variable predictive value in the different series.…”

Section: Introductionmentioning

confidence: 79%

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

et al. 2012

View full text Add to dashboard Cite

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

show abstract

“…Chronic renal insufficiency and/or proteinuria especially in type 2 diabetes may stem from chronic renal disease other than classic diabetic nephropathy. In a recent retrospective study of 69 patients with type 2 diabetes with renal biopsies, 52% had non diabetes-related nephropathy (Mou S, 2010). Selection bias most likely plays a role in these data, as renal biopsies are typically performed in these patients if co-morbidity is suspected.…”

Section: Biomarker Studiesmentioning

confidence: 99%