Clinicopathological Analysis Of Patients With Type 2 Diabetes Mellitus Complicated With Chronic Kidney Disease

OBJECTIVE:In recent years,the epidemiology of diabetic nephropathy?DN?has undergone tremendous changes.This study aimed to analyze the clinicopathological features of patients with type 2 diabetes mellitus?T2DM?complicated with chronic kidney disease?CKD?in recent years,and to explore a differential diagnosis model of diabetic nephropathy and non-diabetic nephropathy?NDRD?in type 2 diabetes patients?METHODS:213 patients with type 2 diabetes mellitus?T2DM?complicated with chronic kidney disease?CKD?underwent renal biopsy at the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed.According to the pathological results of renal biopsy,the patients were divided into DN group,NDRD group and superimposed?DN+NDRD?group,Clinical and laboratory data were compared between three groups;Then a diagnostic model was developed based on the logistic regression analysis.RESULTS:The pathological results of renal biopsy showed that DN 74cases?34.7%?,NDRD 130 cases?61.0%?,DN+NDRD 9 cases?4.2%?.NDRD including a variety of pathological types,the most common type is IMN,accounting for 46%of all NDRD patients,followed by FSGS and IgA nephropathy,accounting for 15%and 14%,respectively.Multivariate logistic regression analysis showed absent of DR?OR=28.198,95%CI 8.657⁹1.842,P<0.001?,no large amount of proteinuria?urinary protein quantification?3.5g/d??OR=9.654,95%CI 1.323⁹.654,P=0.012?,absent of anemia?OR=9.181,95%CI 2.986²8.228,P<0.001?,and eGFR?90mL/min/1.73 m 2?OR=6.379,95%CI 1.584²5.686,P=0.009?are independent risk factors for NDRD.Based on the logistic regression model:logit?P?=₀+₁(3(3₁+₂(3(3₂+…+₈8))(3(3₈8)),a diagnostic model for NDRD was constructed as follows:PNDRD=1/1+e-?0.405+3.339×DR+1.274×Proteinuria+2.217×anemia+1.853×eGFR?P_NDRD was the probability of NDRD diagnosis(P_NDRD?0.5 as NDRD,P_NDRD<0.5 as DN).Validation tests showed that this model had good sensitivity?83.8%?and specificity?87.9%?.The diagnostic accuracy is 85.5%,and the area under the ROC curve is 0.925.CONCLUSION:T2DM with CKD patients with a high incidence of NDRD including a variety of pathological types;absent of DR,without large amount of proteinuria,absent of anemia,eGFR?90mL/min/1.73 m²independent risk factors for NDRD,a single indicator for the diagnostic performance of NDRD is general,and the multi-factor joint prediction model can effectively improve the accuracy of NDRD diagnosis.