Type 2 Diabetic Renal Damage In Clinical And Pathological Study

Backgroud"K/DOQI clinical practice guidelines and clinical practice recommendations fordiabetes and chronic kidney disease" had replaced the traditional "diabeticnephropathy(DN)" with "diabetic kidney disease(DKD)" as a clinical diagnosis and"diabetic glomerulopathy(DG)" as a pathological diagnosis for diabetics withproteinuria in 2007. But the renal structural heterogeneity in type 2 diabetics withchronic disease (CKD) still lack of precise pathological classification criteria.ObjectiveTo analyze the clinical and pathological features of type 2 diabetics with CKD andfind predictive clinical features favouring the pathological diagnosis.MethodsCase selection: the type 2 diabetics undergoing renal biopsy in PUMCH between2001 and 2007, with intact clinical and pathological data. Groups: typical diabeticglomerulopathy(DG, n=29), atypical diabetes-related renal disease(ADRD, n=20),non-diabetic renal disease(NDRD, n=93), DG+NDRD(n=13). This retrospectivestudy compared the clinical and pathological features and evaluated the value ofclinical features to predict the pathological diagnosis.Results(1) Among 155 patiens, 29(18.7%) patients were classified as DG, 20(12.9%) asADRD, 13 (8.4%) presented with both DG and NDRD, and 93(60.0%) as NDRD onlyin which IgA nephropathy was the most common type. (2) The duration of diabeteswas longer, fasting blood glucose (FBG), systolic blood pressure (SBP), mean arterialpressure (MAP) and proteinuria were higher, diabetic retinopathy (DR) was morecommon, and glomerular filtration rate (GFR) was lower in DG patients than inADRD and NDRD patients. The age was younger, body mass index (BMI) andincidences of obesity were higher, but incidences of glomerular microscopichematuria, edema, mass proteinuria, nephrotic syndrome and anemia were lower inADRD patients than in DG patients. Incidences of mass proteinuria and anemia were lower in NDRD patients than in DG patients, and gross hematuria and acute renal function decreasing could be only found in NDRD patients. (3) In DG patients, GFR was significantly counter-related with glomerular global sclerosis rate, and proteinuria was significantly correlated with Vv (mes/glom). In ADRD patients, GFR was significantly counter-related with glomerular global sclerosis rate, and there was no significant correlation between proteinuria and pathological features. (4) For predicting DG, the high sensitive index was DR (82.8%), and DR (89.2%), proliferative DR (100%) and duration of diabetes over 5 years (77.9%) ranked in the high specific indexes; for predicting NDRD, the sensitivities of all the indexes were low, but gross hematuria (100.0%), acute decrease of renal function (100.0%), proves of autoimmune diseases (85.7%) and proteinuria≥3.5g/24h but eGFR≥60ml/min (89.6%) ranked in the high specific ones.Conclusions(1) Renal injury of type 2 diabetes with CKD are structural heterogeneous, may resulted from DG, NDRD or both DG and NDRD, and some could resulted from atypical patterns of renal pathology which we defined as ADRD. (2) ADRD patients were different from DG patients in renal pathology, clinical features and relationship between renal structures and renal function. (3) DR and duration of diabetes over 5 years are helpful in predicting DG, and history of gross hematuria, acute decrease of renal function, proves of autoimmune diseases and proteinuria≥3.5g/24h but eGFR≥60ml/min are helpful in predicting NDRD.