Renal biopsy in patients with type 2 diabetes mellitus: indications and nature of the lesions

Abstract

BACKGROUND AND OBJECTIVES:The prevalence of non diabetic renal disease (NDRD) among patients with type 2 diabetes mellitus varies widely depending on the selection criteria and the populations being studied. The aim of this study was to evaluate the renal biopsies performed on type 2 diabetic patients for suspicion of NDRD and to correlate the pathological with the clinical and laboratory findings.SUBJECTS AND METHODS:We selected and reviewed biopsies performed on type 2 diabetics for clinically suspected NDRD from January 2006 to December 2008 at a single hospital. Clinical and laboratory data were analyzed in relation to the histopathology findings. Patients were grouped into either group I with isolated DGS or group II with NDRD on top of DGS.RESULTS:Thirty-one biopsies were performed on type 2 diabetic patients; Seventeen patients (54.8%) were males. Mean age was 50.68 (11.29) years. The mean duration of diabetes was 9.33 (3.6) years. Renal biopsy showed that among the studied group 14 patients (45.2%) showed NDRD on top of DGS. Crescentic glomerulonephritis was the commonest finding seen in 3 cases (21.4% of group II cases) followed by acute tubulointerstitial nephritis and hypertensive changes each was seen in 2 cases (14.4%). Other findings included IgA nephropathy, primary focal segmental glomerulosclerosis, rhabdomyolysis, membranoproliferative glomerulonephritis each of them was seen in one case (7.1%). Group I had a significantly higher level of proteinuria 4.97 (2.08) gm/24 hrs urine than group II 2.72 (1.09) gm/24 hrs urine (P=.003). There was no significant difference between the two groups in age, duration of diabetes, gender, presence of hypertension, hematuria, serum creatinine or glomerular filtration rate.CONCLUSION:The present study showed that crescentic glomerulonephritis is the commonest NDRD among diabetic patients. A higher level of proteinuria was reported among those with NDRD superimposed on DGS. So, Renal biopsy should be performed in diabetics when the clinical scenario is atypical.

Prevalence of diabetic nephropathy complicating non-diabetic renal disease among Chinese patients with type 2 diabetes mellitus

“…The high prevalence of IgA nephropathy was in accordance with findings from the aforementioned literature review, which showed prevalence rates ranging from 7.1% to 44.8% [10,15,16,21,28,30]. The disease spectrum of DN complicating NDRD in China might be thought to be different from that in other parts of the world.…”

Nondiabetic kidney disease in type 2 diabetic patients: A single center experience

“…[2] A recent study from Taiwan observed AKI(58.8%) in majority of patients while in Kuwait, it was hematuria. [1426] From these review of literatures, it is obvious that presenting syndrome can be different.…”

“…A study from Thailand showed MN as commonest NDRD, while in Kuwait, it was CresGN. [2629] Conversely, Shan and Pham reported FSGS as the most common NDRD. [1517] These results suggest that prevalence of different category of biopsy-proven renal disease in diabetic patients depends on the usual prevalence of renal disease in the total population according to the geographical area and ethnic characteristics and NDRD is merely a coincidental in type 2 DM.…”

Identifying Parameters to Distinguish Non-Diabetic Renal Diseases from Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis

“…Nephrologists are sometimes reluctant to perform a renal biopsy on patients with DM because of the potential risks of the procedure such as hematuria, perirenal hematoma, arterial embolization, and even the necessity for a nephrectomy [10]. Moreover, there exist some contraindications for renal biopsy such as the solitary kidney and cortical atrophy [11]. Additionally, many primary hospitals are at present unable to perform the renal biopsy.…”