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Renal outcomes and clinical course of nondiabetic renal diseases in patients with type 2 diabetes

  • Byun, Ja Min (Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Lee, Cheol Hyun (Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Lee, Sul Ra (Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Moon, Ju Young (Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Lee, Sang Ho (Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Lee, Tae Won (Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Ihm, Chun Gyoo (Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Jeong, Kyung Hwan (Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine)
  • 투고 : 2012.08.29
  • 심사 : 2013.01.11
  • 발행 : 2013.09.01

초록

Background/Aims: In several recent studies, renal biopsies in patients with type 2 diabetes and renal disease have revealed a heterogeneous group of disease entities. Our aim was to study the prognosis and clinical course of nondiabetic renal disease (NDRD) and to determine risk factors for NDRD in patients with type 2 diabetes. Methods: Renal biopsy reports of 110 patients with type 2 diabetes who were seen at Kyung Hee University Medical Center and Kyung Hee University Hospital at Gangdong, Seoul, Korea between January 2000 and December 2011 were retrospectively analyzed. Results: Of 110 patients with type 2 diabetes, 41 (37.3%) had diabetic nephropathy (DN), 59 (53.6%) had NDRD, and 10 (9.1%) had NDRD superimposed on DN. Immunoglobulin A nephropathy (43.5%) was the most common NDRD. Patients with NDRD had a shorter duration of diabetes, lower frequency of diabetic retinopathy, and better renal outcomes, which might have resulted from the use of aggressive disease-specific treatments such as steroids and immunosuppressants in patients with NDRD. Conclusions: Compared with DN, NDRD was associated with better renal outcomes in patients with type 2 diabetes, as evidenced by a higher cumulative renal survival rate and lower rate of end-stage renal disease (ESRD). Shorter duration of diabetes and absence of retinopathy were independent predictors of NDRD in patients with type 2 diabetes and renal involvement. Renal biopsy is recommended for patients with type 2 diabetes and risk factors for NDRD, to obtain an accurate diagnosis, prompt initiation of disease-specific treatment, and ultimately better renal outcomes with the avoidance of ESRD.

키워드

참고문헌

  1. Kikkawa R, Koya D, Haneda M. Progression of diabetic nephropathy. Am J Kidney Dis 2003;41(3 Suppl 1):S19-S21. https://doi.org/10.1053/ajkd.2003.50077
  2. Pham TT, Sim JJ, Kujubu DA, Liu IL, Kumar VA. Prevalence of nondiabetic renal disease in diabetic patients. Am J Nephrol 2007;27:322-328. https://doi.org/10.1159/000102598
  3. Lee HB, Seo JY, Yu MR, Uh ST, Ha H. Radical approach to diabetic nephropathy. Kidney Int Suppl 2007;(106):S67-S70.
  4. Mather HM, Chaturvedi N, Kehely AM. Comparison of prevalence and risk factors for microalbuminuria in South Asians and Europeans with type 2 diabetes mellitus. Diabet Med 1998;15:672-677. https://doi.org/10.1002/(SICI)1096-9136(199808)15:8<672::AID-DIA648>3.0.CO;2-3
  5. Earle KA, Mehrotra S, Dalton RN, Denver E, Swaminathan R. Defective nitric oxide production and functional renal reserve in patients with type 2 diabetes who have microalbuminuria of African and Asian compared with white origin. J Am Soc Nephrol 2001;12:2125-2130.
  6. Korbet SM. Percutaneous renal biopsy. Semin Nephrol 2002;22:254-267. https://doi.org/10.1053/snep.2002.31713
  7. Soni SS, Gowrishankar S, Kishan AG, Raman A. Non diabetic renal disease in type 2 diabetes mellitus. Nephrology (Carlton) 2006;11:533-537. https://doi.org/10.1111/j.1440-1797.2006.00681.x
  8. Lin YL, Peng SJ, Ferng SH, Tzen CY, Yang CS. Clinical indicators which necessitate renal biopsy in type 2 diabetes mellitus patients with renal disease. Int J Clin Pract 2009;63:1167-1176. https://doi.org/10.1111/j.1742-1241.2008.01753.x
  9. Lee EY, Chung CH, Choi SO. Non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus. Yonsei Med J 1999;40:321-326. https://doi.org/10.3349/ymj.1999.40.4.321
  10. Haddiya I, Hamzaoui H, Al Hamany Z, et al. Isolated non diabetic renal disease in diabetic patients: a Moroccan report. Saudi J Kidney Dis Transpl 2010;21:555-558.
  11. Zhou J, Chen X, Xie Y, Li J, Yamanaka N, Tong X. A differential diagnostic model of diabetic nephropathy and non-diabetic renal diseases. Nephrol Dial Transplant 2008;23:1940-1945. https://doi.org/10.1093/ndt/gfm897
  12. Ghani AA, Al Waheeb S, Al Sahow A, Hussain N. Renal biopsy in patients with type 2 diabetes mellitus: indications and nature of the lesions. Ann Saudi Med 2009;29:450-453. https://doi.org/10.4103/0256-4947.57167
  13. Jalalah SM. Non-diabetic renal disease in diabetic patients. Saudi J Kidney Dis Transpl 2008;19:813-816.
  14. Mak SK, Gwi E, Chan KW, et al. Clinical predictors of non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus. Nephrol Dial Transplant 1997;12:2588-2591. https://doi.org/10.1093/ndt/12.12.2588
  15. Wong TY, Choi PC, Szeto CC, et al. Renal outcome in type 2 diabetic patients with or without coexisting nondiabetic nephropathies. Diabetes Care 2002;25:900-905. https://doi.org/10.2337/diacare.25.5.900
  16. Chang JH, Kim DK, Kim HW, et al. Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience. Nephrol Dial Transplant 2009;24:2406-2410. https://doi.org/10.1093/ndt/gfp091
  17. Woo KT, Chan CM, Chin YM, et al. Global evolutionary trend of the prevalence of primary glomerulonephritis over the past three decades. Nephron Clin Pract 2010;116:c337-c346. https://doi.org/10.1159/000319594
  18. Braden GL, Mulhern JG, O'Shea MH, Nash SV, Ucci AA Jr, Germain MJ. Changing incidence of glomerular diseases in adults. Am J Kidney Dis 2000;35:878-883. https://doi.org/10.1016/S0272-6386(00)70258-7
  19. Weng CH, Hu CC, Yu CC, et al. Immunoglobulin G levels can predict non-diabetic renal disease in patients with type 2 diabetes mellitus. J Diabetes 2012;4:37-40. https://doi.org/10.1111/j.1753-0407.2011.00175.x
  20. Serra A, Romero R, Bayes B, Lopez D, Bonet J. Is there a need for changes in renal biopsy criteria in proteinuria in type 2 diabetes? Diabetes Res Clin Pract 2002;58:149- 153. https://doi.org/10.1016/S0168-8227(02)00131-6
  21. Chang TI, Park JT, Kim JK, et al. Renal outcomes in patients with type 2 diabetes with or without coexisting non-diabetic renal disease. Diabetes Res Clin Pract 2011;92:198-204. https://doi.org/10.1016/j.diabres.2011.01.017

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  8. Clinical predictive factors in diabetic kidney disease progression vol.8, pp.1, 2013, https://doi.org/10.1111/jdi.12533
  9. The large spectrum of renal disease in diabetic patients vol.10, pp.2, 2017, https://doi.org/10.1093/ckj/sfw137
  10. Clinicopathological features of diabetic and nondiabetic renal diseases in type 2 diabetic patients with nephrotic-range proteinuria vol.96, pp.36, 2013, https://doi.org/10.1097/md.0000000000008047
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  13. Diabetes mellitus as a cause or comorbidity of chronic kidney disease and its outcomes: the Gonryo study vol.22, pp.2, 2013, https://doi.org/10.1007/s10157-017-1451-4
  14. The modern spectrum of biopsy-proven renal disease in Chinese diabetic patients—a retrospective descriptive study vol.6, pp.None, 2013, https://doi.org/10.7717/peerj.4522
  15. Diagnostic Performance of Retinopathy in the Detection of Diabetic Nephropathy in Type 2 Diabetes: A Systematic Review and Meta-Analysis of 45 Studies vol.62, pp.2, 2013, https://doi.org/10.1159/000500833
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  17. Critères d’indications de la biopsie rénale chez les patients diabétiques de type 2 protéinuriques : enquête auprès des néphrologues frança vol.15, pp.7, 2013, https://doi.org/10.1016/j.nephro.2019.05.004
  18. Predictors and histopathological characteristics of non‐diabetic renal disorders in diabetes: a look from the tubulointerstitial point of view vol.49, pp.12, 2019, https://doi.org/10.1111/imj.14334
  19. Non-Diabetic Renal Disease in Patients with Type 2 Diabetes Mellitus with Proteinuria vol.7, pp.12, 2013, https://doi.org/10.4236/jbm.2019.712007
  20. Insights into the Role of Renal Biopsy in Patients with T2DM: A Literature Review of Global Renal Biopsy Results vol.11, pp.9, 2013, https://doi.org/10.1007/s13300-020-00888-w
  21. Current findings of kidney biopsy including nephropathy associated with hypertension and diabetes mellitus in Korea vol.35, pp.5, 2013, https://doi.org/10.3904/kjim.2020.195
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  23. Timing of kidney biopsy in type 2 diabetic patients: a stepwise approach vol.21, pp.1, 2013, https://doi.org/10.1186/s12882-020-01794-w
  24. Kidney Biopsy in Type 2 Diabetes: A Multicenter Cross-Sectional Study vol.52, pp.2, 2013, https://doi.org/10.1159/000514259
  25. Clinical Predictors of Nondiabetic Kidney Disease in Patients with Diabetes: A Single-Center Study vol.2021, pp.None, 2021, https://doi.org/10.1155/2021/9999621
  26. Urinary mRNA Signatures as Predictors of Renal Function Decline in Patients With Biopsy-Proven Diabetic Kidney Disease vol.12, pp.None, 2013, https://doi.org/10.3389/fendo.2021.774436
  27. A retrospective cohort study on the pathology and outcomes of type 2 diabetic patients with renal involvement vol.53, pp.2, 2013, https://doi.org/10.1007/s11255-020-02657-x
  28. Non-diabetic glomerular lesions in diabetic kidney disease: clinical predictors and outcome in an Eastern European cohort vol.53, pp.4, 2013, https://doi.org/10.1007/s11255-020-02681-x