Rapidly Progressive Renal Failure in Type 2 Diabetes in the Tropical Environment: A Clinico-Pathological Study

Moger, Venkatesh; Kumar, Santosh; Sakhuja, Vinay; Joshi, Kusum; Walker, R G; Kohli, Harbir Singh; Sud, Kamal; Gupta, Krishan Lal; Jha, Vivekanand

doi:10.1080/08860220500200205

Cited by 19 publications

(13 citation statements)

References 18 publications

(17 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…12 In a large Italian study of type 2 diabetic patients who underwent renal biopsy, Mazzucco et al 13 found that 70% of cases of PIGN occurred in patients with preexisting diabetic nephropathy. Compared to diabetic patients without renal involvement, patients with diabetic nephropathy are more likely to have advanced end-organ damage, including neuropathy and peripheral vascular disease, 14 and hence are at greater risk for the development of skin ulcers with superimposed bacterial infection.…”

Section: Discussionmentioning

confidence: 99%

IgA-Dominant Postinfectious Glomerulonephritis: Not Peculiar to Staphylococcal Infection and Diabetic Patients

Wen

Chen

2011

Renal Failure

View full text Add to dashboard Cite

Background: IgA-dominant postinfectious glomerulonephritis (PIGN) is a unique form of PIGN. It has been linked to staphylococcal infection and underlying diabetic glomerulosclerosis. However, the significance of glomerular IgA-dominant deposition in PIGN remains unclear. Methods: We reported 10 patients with IgA-dominant PIGN encountered at a single center, each characterized by subepithelial humps. Their demographic, clinical, and renal biopsy findings were summarized and compared with the data of 32 patients with non-IgA-dominant PIGN. Results: The mean age was 57 years. An immunocompromised background was present in 70% of patients; only one patient had diabetes mellitus. The causative infectious agents included Staphylococcus (30%), Streptococcus (20%), and gram-negative organisms (50%). Decreased serum complement was present in 60%. Increased serum IgA was noted in 75%. The mean peak serum creatinine was 5.1 mg/dL, and 20% required acute dialysis. Diffuse endocapillary-proliferative glomerulonephritis was found in all cases, and three patients also had crescentic glomerulonephritis. Electron microscopy revealed large subepithelial hump-shaped deposits in all cases. At the last follow-up, one patient had died, five had achieved complete recovery, three had persistent renal insufficiency, and one was on chronic dialysis. Compared to patients with non-IgA-dominant PIGN, increased serum IgA was more commonly present in IgA-dominant group ( p = 0.007). There were no significant differences in other clinical parameters and outcome between the two groups. Conclusions: IgA-dominant PIGN resembles poststreptococcal glomerulonephritis in its histological spectrum and ultrastructural appearance. Increasing serum IgA may be involved in the pathogenesis of this form of PIGN. Our data suggested that IgA-dominant PIGN was not peculiar to staphylococcal infection and diabetic patients.

show abstract

Section: Discussionmentioning

confidence: 99%

IgA-Dominant Postinfectious Glomerulonephritis: Not Peculiar to Staphylococcal Infection and Diabetic Patients

Wen

Chen

2011

Renal Failure

View full text Add to dashboard Cite

show abstract

“…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.

121

131

View full text Add to dashboard Cite

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.

show abstract

“…Existe otra serie de estudios que se han focalizado en ERND, pero con una población de pacientes básicamente macroalbuminúricos, o con síndrome nefrótico, en quienes el hallazgo predominante fue la glomeruloesclerosis focal segmental y ND [23][24][25] . En otras situaciones, se han analizado pacientes diabéticos con deterioro renal rápidamente progresivo, resaltándose, en ellos, glomerulonefritis postinfecciosa, glomerulonefritis rápidamente progresiva y nefritis intersticial aguda 26,27 . Hay pocos trabajos que se hayan centralizado en una población semejante a la que nosotros estudiamos: principalmente ancianos diabéticos, con baja tasa de filtración glomerular y no macroalbuminuria.…”

Section: Discussionunclassified

Características clínicas de una población de diabéticos tipo 2 con alteración en la función renal no macroalbuminúricos

Gómez

Valencia

Arango

2017

Rev. Colomb. Nefrol.

View full text Add to dashboard Cite

OriginalCaracterísticas clínicas de una población de diabéticos tipo 2 con alteración en la función renal no macroalbuminúricos ResumenAntecedentes: aunque la principal causa de deterioro en la función renal en pacientes diabéticos es la nefropatía diabética (ND), existen otras causas que siempre se deben investigar, especialmente cuando en ellos no se detecta macroalbuminuria. Objetivo: caracterización de variables demográficas, clínicas y etiológicas encontradas en una población de diabéticos tipo 2 de más de 10 años de evolución, no macroalbuminúricos, con elevación de azoados. Métodos: se identificaron 67 pacientes, en los cuales se practicaron diversos estudios imagenológicos para lograr un diagnostico etiológico. Si los estudios no fueron concluyentes, se procedió a practicar biopsia renal percutánea Resultados: la media de edad fue de 73,4 años (DE: 9,3). Media de creatinina 1,8 mg/dl, 50,75 % de los pacientes presentaron albuminuria normal (A1) y 49,3 % albuminuria moderadamente incrementada (A2). En 28 pacientes se obtuvo diagnósticos por imágenes, siendo la nefropatía hipertensiva el principal hallazgo. Se practicó biopsia renal al 58,20 % de la población (39 pacientes) y, en ellos, los diagnósticos fueron: ND aislada en el 28 % de los casos (11 pacientes), nefroesclerosis hipertensiva 28 % (11 pacientes), nefropatía mixta (diabética e hipertensiva) 18 % (7 pacientes), nefropatía por IgA 5 % (2 pacientes). Conclusiones: la nefropatía hipertensiva es la principal causa de elevación de azoados en diabéticos tipo 2 no macroalbuminúricos. La ND aislada sólo explica el 16,42 % (11 pacientes) de las causas de esta población.Palabras clave: nefropatías, diabetes mellitus, albuminuria, biopsia con aguja.doi: http://dx.doi.org/10.22265/acnef.4.2.271Abstract Background: The main cause of impaired renal function in diabetic patients is diabetic nephropathy (ND), but there are other causes that should always be investigated especially when they do not detect macroalbuminuria. Aims: Characterization of demographic, clinical and etiological variables found in a population of type 2 diabetics over 10 years of non-macroalbuminuric evolution with nitrogen products elevation. Methods: We identified 67 patients, in whom several imaging studies were performed to obtain an etiological diagnosis. If the studies were inconclusive, percutaneous renal biopsy was performed. Results: The mean age was 73.4 years (SD: 9.3). Mean creatinine 1.8 mg / dl, 50.75% of the patients had normal albuminuria (A1) and 49.3% moderately increased albuminuria (A2). In 28 patients, imaging diagnoses were obtained, with hypertensive nephropathy being the main finding. A total of 58.20% (39 patients) of the population were submitted to renal biopsy. ND was detected in the 28% of cases (11 patients), hypertensive nephrosclerosis 28% (11 patients), mixed nephropathy (diabetic and hypertensive) 18% (7 patients), 5% IgA nephropathy (2 patients).Conclusions: Hypertensive nephropathy is the main cause of elevated nitrogen products in non-macroalbuminuri...

show abstract

Rapidly Progressive Renal Failure in Type 2 Diabetes in the Tropical Environment: A Clinico-Pathological Study

Cited by 19 publications

References 18 publications

IgA-Dominant Postinfectious Glomerulonephritis: Not Peculiar to Staphylococcal Infection and Diabetic Patients

IgA-Dominant Postinfectious Glomerulonephritis: Not Peculiar to Staphylococcal Infection and Diabetic Patients

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

Características clínicas de una población de diabéticos tipo 2 con alteración en la función renal no macroalbuminúricos

Contact Info

Product

Resources

About