Renal Outcome in Type 2 Diabetic Patients With or Without Coexisting Nondiabetic Nephropathies

Wong, Tak Ming; Choi, Pui–Wah; Szeto, Cheuk‐Chun; To, Ka Fai; Tang, Nelson L.S.; Chan, Anthony W.H.; Li, Philip Kam-Tao; Lai, Fernand Mac‐Moune

doi:10.2337/diacare.25.5.900

Cited by 118 publications

(138 citation statements)

References 24 publications

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“…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: 55%

“…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: 46%

“…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%

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The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

Sharma

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Radhakrishnan

et al. 2013

Clinical Journal of the American Society of Nephrology

260

233

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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.

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Section: Discussionsupporting

confidence: 55%

Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 66%

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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

260

233

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“…Of 23 patients with TGCBM, 17 were identified in 1999, 4 2000, 6 and 2001, 7 while only one patient in each of the 6 previous years was diagnosed, and indication of biopsy for proteinuria of 1 g/day or more was unchanged. The clinical features of all groups at the time of biopsy are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…5,6 Nevertheless, early renal lesions in diabetic patients, especially in type II diabetes remain poorly described, because of the policy to withhold biopsy, unless atypical presentation raises the suspicion of nondiabetic lesions, which may affect both the management and prognosis. 2,3,4,7 Moreover, TGCBM has been described in nondiabetic patients, associated with hypertension and smoking, but the correlation of TGCBM to these factors remains to be established. 8 This report examined the clinical features and follow-up of 23 patients with an isolated diffuse TGCBM.…”

mentioning

confidence: 99%

Isolate diffuse thickening of glomerular capillary basement membrane: a renal lesion in prediabetes?

et al. 2004

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A total of 23 patients with proteinuria and isolated ultrastructural diffuse thickening of the glomerular capillary basement membrane were studied, focusing on the possibility of diabetes mellitus, morphometry of the capillary basement membrane, and the comparison with three other groups of patients. These included 14 patients with minimal change nephropathy (MCN), 45 patients with type II diabetes arbitrarily divided into 11 early and 34 late diabetic patients, defined, respectively, as less than 3 and over 5 years history, and 13 patients biopsied for transient mild proteinuria or hematuria, with no evidence of renal disease on follow-up were used as controls. The level of proteinuria and prevalence of hematuria were similar in patients with isolated thick basement membrane and with diabetes. Diabetic retinopathy was present in 10% of early diabetes, 69% of late diabetes, but not in isolated thick basement membrane. Kimmelstiel-Wilson nodules were seen in late diabetes, and not in other patients. Hyaline arteriosclerosis was more common in late diabetes than in early diabetes or isolated thick basement membrane. The basement membrane thickness was similar between controls (371717 nm) and MCN (345716 nm), between patients with isolated thick basement membrane (482769 nm) and early diabetes (457764 nm), but significantly thicker in isolated thick basement membrane as compared to controls and MCN. In patients with isolated thick basement membrane, the basement membrane thickness was not correlated with age, smoking, body weight, hyaline arteriosclerosis, and hypertension. However, blood tests for diabetes were positive in 20% of patients at biopsy, in 44% at 6 months and 70% at 24 months followup, while seven patients showed no evidence of diabetes on follow-up. Patients with proteinuria and isolated thick glomerular basement membrane must be differentiated from MCN for therapeutic implications, and specifically managed for its strong association with prediabetes or early diabetes.

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Current literature in diabetes

2003

Diabetes Metabolism Res

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 26 sections: 1 Books, Reviews & Symposia; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Prediction; 7 Prevention; 8 Intervention: a) General; b) Pharmacology; 9 Pathology: a) General; b) Cardiovascular; c) Neurological; d) Renal; 10 Endocrinology & Metabolism; 11 Nutrition; 12 Animal Studies; 13 Techniques. Within each section, articles are listed in alphabetical order with respect to author (9 Weeks journals ‐ Search completed at 8th May 2003)

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Renal Outcome in Type 2 Diabetic Patients With or Without Coexisting Nondiabetic Nephropathies

Cited by 118 publications

References 24 publications

The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

The Modern Spectrum of Renal Biopsy Findings in Patients with Diabetes

Isolate diffuse thickening of glomerular capillary basement membrane: a renal lesion in prediabetes?

Current literature in diabetes

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