Clinical And Pathological Analysis Of Non-diabetic Renal Damage In Patients With Type 2 Diabetes Mellitus

Backgroud:Type 2 diabetes mellitus with increasing incidence, has become one of the most important health problems worldwide. Diabetic kidney disease is a very common complication of diabetes and has been the first cause of end-stage renal disease in developed countries, while the number is increasing year by year in China too. However, the diabetic kidney disease in diabetic patients isn’t the only form of the kidney injury. The other injury forms apart from the diabetic kidney disease are collectively referred to as non-diabetic renal disease (NDRD). Different from the diabetic kidney disease, non-diabetic renal disease includes a variety of kidney damage forms. There are significant heterogeneity in the clinical, pathological features and prognosis of renal injury in type 2 diabetes, clinical and pathological diagnosis of these diseases have decisive influence on the selection of the treatment. But it is not uniform on the point of the clinical and pathological diagnosis method to this kind of patients.Objective:To analyze the pathological characteristics and distribution of renal injury in patients with type 2 diabetes. Comparison between diabetic kidney disease and non-diabetic renal disease in clinical characteristics, to find important risk factor for non-diabetic renal disease.Methods:To conduct retrospective analysis of clinical, laboratory and pathohistological data of type 2 diabetes mellitus patients conforming to the WHO, ADA and EASD diagnosis standard in whom renal biopsies were performed from March 2010 to September 2014 in Shandong Provincial Hospital affiliated Shandong University (n=88). According to the pathological characteristics, they are divided into:diabetic kidney disease group (DKD), non-diabetic renal disease group (NDRD), diabetic kidney disease superimposed on non-diabetic renal disease group (DKD+NRDR). To compare the clinical and pathological features of cases of all groups and evaluate the clinical parameters on the predictive value to the diagnosis of non-diabetic renal disease.Results:According to the findings of renal biopsy, isolated diabetic kidney disease was found in 20.46%, isolated non-diabetic renal disease in 72.73% and non-diabetic renal disease superimposed on diabetic kidney disease in 6.82% of the patients. The most common non-diabetic renal diseases found were:membranous nephropathy, followed by IgA nephropathy and focal segmental glomerulosclerosis. In univariate analysis, lower level of fasting blood glucose, absence of hypertension and absence of diabetic retinopathy were found to be significant clinical predictors of non-diabetic renal disease. In multivariate logistic-analysis, only lower level of fasting blood glucose (< 9.88 mmol/L) (OR 0.714; 95%CI=0.543-0.939; p=0.016) and absence of diabetic retinopathy (OR 18.602; 95%CI=2.176-159.018; p=0.003) were independent predictors of non-diabetic renal disease.Conclusions:This study confirmed the high prevalence (72.73%) of non-diabetic renal disease in type 2 diabetic patients with renal injury, in which membranous nephropathy, IgA nephropathy and focal segmental glomerulosclerosis are common. Since non-diabetic renal disease are potentially curable, we should consider renal biopsy in selected type 2 diabetes mellitus patients with renal involvement, especially in those with lower level of fasting blood glucose (<9.88 mmol/L) and absence of diabetic retinopathy.