Clinical And Pathological Comparison Of Type 2 Diabetic Kidney Disease And Type 2 Diabetes Mellitus With Non-diabetic Renal Disease

Objectives:To compare the renal clinical data and pathological features of type 2 diabetic kidney disease and type 2 diabetes mellitus with NDRD.Further to explore the predictors of type 2 diabetes mellitus with NDRD and evaluate their predictive value of type 2 diabetes mellitus with NDRD.Methods:One hundred and fourty six cases of type 2 diabetes mellitus with proteinuria were enrolled by renal biopsy.The clinical and laboratory data as well as histological characters were analyzed retrospectively from November 2010 to October 2016.All objects were accorded with the inclusion criteria and has a complete general clinical data and laboratory parameters.According to renal pathology features,the patients were divided into three groups,typical diabetic glomerulapathy group(DG group,n = 30 cases),atypical diabetic-related renal diseases group(ADRD group,n = 6 cases)and non-diabetic renal disease group(NDRD group,n = 110 cases),we analyzed and compared the clinical and pathological characters among typical DG group,ADRD group and NDRD group.Further to explored the predictors of type 2 diabetes mellitus with NDRD and evaluated their predictive value by calculating the area under ROC curve,the sensitivity,specificity,total coincidence rate,positive predictive value and negative predictive value.SPSS22.0 software was adopted for statistical analysis.Results:1.There are 146 cases of patients with clinical diagnosis of type 2 diabetes mellitus with overt albuminuria receiving renal biopsy from November 2010 to October 2016 in our hospital,NDRD accounted for 75.3% in type 2 diabetes mellitus with albuminuria.In the NDRD patients,the most common pathological type was membranous nephropathy,nephrotic syndrome was the main clinical manifestations.2.Typical DG group and ADRD group compare to NDRD group,diabetic mellitus history was longer,incidence of DR is higher and DR stages was more serious;typical DG group compare to NDRD group,the systolic blood pressure and mean arterial pressure was higher,eGFR was lower;ADRD group compared with NDRD group,the level of serum Cys-C is lower,and so was the incidence of hypertension.3.Diabetic retinopathy positive rate was 67.7% in T2 DKD,and22.8% in NDRD,non proliferation diabetic retinopathy was the main clinical manifestations of NDRD.4.Diabetes mellitus history<5 years,absence of DR,hematuria,eGFR?60 ml/min/1.73m~2 have predictive value to differential diagnosis of type 2 diabetes mellitus with NDRD,diabetic mellitus history<5 years was the most significant predictive factor of NDRD.Conclusions:1.The incidence of diabetic retinopathy in the typical DG and ADRD group was higher than NDRD group and the course of diabetes mellitus was longer;the typical DG has higher systolic blood pressure,average arterial pressure,lower eGFR than NDRD group.Compared with NDRD group,the incidence of hypertension was lower in ADRD group.2.Among type 2 diabetes mellitus combined with overt albuminuria,type 2 diabetes mellitus with NDRD accounted for 75.3 %,the most common pathological type is membranous nephropathy,nephrotic syndrome was the main clinical manifestation of NDRD group.3.The course of diabetic mellitus<5 years,without diabetic retino –pathy,hematuria and eGFR?60 ml/min/1.73m~2 have predictive value for the diagnosis of type 2 diabetes mellitus with NDRD,in which diabetes mellitus course< 5 years has the most predictive value.