Clinicopathological Features And Renal Prognosis In 507 Patients With Type 2 Diabetes Mellitus Complicated With Chronic Kidney Disease

ObjectiveTo analyze the clinicopathological features in diabetic kidney disease(DKD)and non-diabetic kidney disease(NDKD)patients,and provide reference for patients who will receive renal biopsy with diabetes mellitus complicated with chronic kidney disease,and then try to evaluate the relationship between the clinical parameters and renal outcomes,to help predict the prognosis of DKD and NDKD.MethodsFirst,the patients with type 2 diabetes mellitus complicated with chronic kidney disease who underwent renal biopsy were collected through the database at the Nanfang Hospital of Southern Medical University from February 2002 to June 2018.According to the results of renal biopsy,they were divided into DKD group and NDKD group(including DKD+NNDKD).The clinical manifestations and pathological types were compared between the two groups.Second,we compared the adverse renal outcomes between DKD and NDKD,and analyze the independent clinical risk factors affecting the prognosis of the two groups.ResultsA total of 507 patients were eventually included in the study.There were 114 cases(22.5%)with DKD and 393 cases(77.5%)with NDKD.Pathologically,the most common pathological types of NDKD were membranous nephropathy(30.0%)and IgA nephropathy(19.1%).Among NDKD patients,5.6%patients had DKD combing with NDKD.In term of the clinical manifestations,DKD patients had a longer history of diabetes(>1 year,76.3%vs 36.1%,P<0.001),higher quantity of urinary protein[3.69(1.70,6.74)g/24 h vs 2.21(0.91,4.97)g/24 h,P<0.001],higher serum creatinine[117.5(85.8,194.5)umol/L vs 89.0(68.0,143.8)umol/L,P<0.001]than NDKD patients.But the hemoglobin[(105.07±20.85)g/L vs(124.41±25.02)g/L,P=0.002]and cholesterol[(5.69±1.87)mmol/L vs(6.43±2.75)mmol/L,P=0.001]in DKD patients were lower than those in NDKD patients.Logistic regression analysis showed that diabetes mellitus history(OR=4.162,95%CI 1.717-10.098,P=0.002),higher systolic pressure(every 1 mmHg,OR=1.028,95%CI 1.011-1.045,P=0.001),history of antihypertensive medication(OR=3.141,95%CI 1.496-6.591,P=0.002),diabetic retinopathy(OR=5.561,95%CI 2.361-13.100,P<0.001)and higher glycated hemoglobin level(every 1%,OR=1.680,95%CI 1.333-2.118,P<0.001)were related factors of DKD,while hematuria(OR=2.781,95%CI 1.334-5.798,P=0.006)and higher hemoglobin level(every 1 g/L,OR=1.022,95%CI 1.008-1.037,P=0.002)were related factors of NDKD.Renal survival analysis showed that the incidence of adverse renal outcomes in DKD was significantly higher than in NDKD(P<0.0001).COX regression analysis showed that 24h urinary protein level(HR=1.165,95%CI 1.051-1.291,P=0.004)was an independent risk factor for DKD adverse renal outcomes.Systolic blood pressure(HR=1.029,95%CI 1.008-1.051,P=0.007)and urinary protein(HR=6.472,95%CI 2.103-19.919,P=0.001)were independent risk factors for NDKD adverse renal outcomes.ConclusionThere are differences in clinical manifestations and pathological types between DKD and NDKD.The history of diabetes,antihypertensive medication,fundus examination,higher of proteinuria and glycosylated hemoglobin may predict DKD,while hematuria and higher level of hemoglobin may have certain guiding significance for the diagnosis of NDKD.The indication of renal biopsy in patients with diabetes mellitus complicated with chronic kidney disease should include comprehensive clinical manifestations.The incidence of adverse renal outcomes in DKD is significantly higher than in NDKD.Urinary protein level has certain predictive value for renal prognosis of DKD and NDKD,and can used as a predictive marker of the progression of DKD and NDKD.