Renal histology in diabetic nephropathy: "A novel perspective"

Abstract

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease all over the world. India has a high incidence and prevalence of diabetes and >30% have nephropathy. Recently, a histological classification has been proposed. This study analyzed the renal histology in 114 diabetic patients with renal dysfunction. Nearly 75% of patients had DN. Fifty five (63.95%) were males. Mean duration of diabetes was 7.04 ± 4.9 years. Mean serum creatinine in study group was 5.2 ± 2.9 mg/dl, with mean estimated glomerular filtration rate of 23.43 ± 21.48 ml/min/1.732 m2. Forty eight patients (55.81%) had diabetic retinopathy (DR); prevalence of DR was more in patients who had diabetes for > 10 years than patients who had diabetes for <6 years (P = 0.022). The most common histological class was Class IV observed in 37 (43.02. %) cases, Class III DN in 24 (27.90%) cases, Class IIa and Class IIb in 11 (12.79%) cases each and Class I DN in 3 (3.48%) cases. Higher histological class was associated with higher proteinuria, lower glomerular filtration rate (P < 0.001) and was more likely to be associated with retinopathy (P = 0.012) and hypertension (P = 0.0003) but did not correlate with duration of diabetes (P = 0.85). There was a poor correlation between retinopathy and DN. Biopsy helps to stage the renal lesions in diabetics with renal dysfunction.

Prevalence of non-diabetic kidney disease and inability of clinical predictors to differentiate it from diabetic kidney disease: results from a prospectively performed renal biopsy study

“…In most of the previous studies, the investigators have found difference in certain parameters between DKD and NDKD, but they have mostly not tested the same in the logistic regression model. [19][20][21] In few studies (retrospective studies of targeted renal biopsies), regression analysis was performed, 22 23 and some even came up with equations 24 25 to predict probability of either DKD or NDKD. However, it is important to appreciate that these equations were of little use for decision making at individual patient level in day-to-day clinical practice.…”

“…In most of the previous studies, the investigators have found difference in certain parameters between DKD and NDKD, but they have mostly not tested the same in the logistic regression model 19–21…”

The Puerarin improves renal function in STZ-induced diabetic rats by attenuating eNOS expression

“…4 During early stages of diabetic nephropathy, functional and structural abnormalities of glomerular capillaries occur. 5 The nitric oxide (NO) is believed to be involved in the early and late alterations of glomerular hemodynamics due to diabetes. [6][7][8] There are at least three NO-synthases, named neuronal NOS (nNOS), endothelial NOS (eNOS) and inducible NOS (iNOS) that are present within the kidney.…”

The eye and the kidney: twin targets in diabetes

“…Clinical situation simplying non-diabetic renal disease includes shorter duration of diabetes, microscopic hematuria and active urinary sediment in the absence of retinopathy [12]. An Indian study showed a poor correlation between DN and DR in type 2 diabetes mellitus and suggested that renal biopsy is useful in staging the lesions in subjects with diabetes having renal dysfunction [13]. A similar discordance between DR and DN in type 2 diabetes was reported, advocating the requirement of renal biopsy for a precise renal pathological diagnosis in these situations [14].…”