Giorgia Comai1, Deborah Malvi2, Andrea Angeletti1, Francesco Vasuri2, Sabrina Valente3, Francesca Ambrosi2, Irene Capelli1, Matteo Ravaioli4, Gianandrea Pasquinelli3, Antonietta D'Errico2, Alessia Fornoni5, Gaetano La Manna6. 1. Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 2. Department of Experimental, Diagnostic and Specialty Medicine, Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 3. Department of Experimental, Diagnostic and Specialty Medicine, Clinical Pathology S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 4. Unit of General and Transplant Surgery Department of Medical and Surgical Sciences University of Bologna, S. Orsola Malpighi Hospital Bologna, Bologna, Italy. 5. Katz Family Drug Discovery Center, Department of Medicine, University of Miami, Miami, Florida, USA. 6. Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy, gaetano.lamanna@unibo.it.
Abstract
BACKGROUND: In the absence of a histological diagnosis, persistent albuminuria is globally accepted as the main diagnostic criteria for diabetic kidney disease (DKD). METHODS: In the present retrospective study, we evaluated data from an Italian cohort of 42 deceased diabetic donors (mainly with type 2 diabetes). Using the kidney biopsies obtained at the time of donation to evaluate single or double allocation based on Karpinski score, we determined the prevalence of histological lesions attributable to diabetes. RESULTS: All 42 donors presented with proteinuria in the normal range and an estimated glomerular filtration rate (eGFR) (chronic kidney disease [CKD]-EPI) >60 mL/min/1.73 m2. A kidney biopsy was available for 36 patients; of these, one was not interpretable and 32 showed histopathological lesions consistent with DKD and encompassing all histological classes. Thus, we found a relatively high proportion of histologically proven DKD that had been clinically undiagnosed, as none of the patient had significant proteinuria and eGFR <60 mL/min/1.73 m2. CONCLUSIONS: The data we present here support the need to implement routine kidney biopsies in normoalbuminuric diabetic subjects in the early stages of CKD. Such strategy may help to improve risk stratification in diabetic patients and guide therapeutic decisions during the early stages of the disease.
BACKGROUND: In the absence of a histological diagnosis, persistent albuminuria is globally accepted as the main diagnostic criteria for diabetic kidney disease (DKD). METHODS: In the present retrospective study, we evaluated data from an Italian cohort of 42 deceased diabetic donors (mainly with type 2 diabetes). Using the kidney biopsies obtained at the time of donation to evaluate single or double allocation based on Karpinski score, we determined the prevalence of histological lesions attributable to diabetes. RESULTS: All 42 donors presented with proteinuria in the normal range and an estimated glomerular filtration rate (eGFR) (chronic kidney disease [CKD]-EPI) >60 mL/min/1.73 m2. A kidney biopsy was available for 36 patients; of these, one was not interpretable and 32 showed histopathological lesions consistent with DKD and encompassing all histological classes. Thus, we found a relatively high proportion of histologically proven DKD that had been clinically undiagnosed, as none of the patient had significant proteinuria and eGFR <60 mL/min/1.73 m2. CONCLUSIONS: The data we present here support the need to implement routine kidney biopsies in normoalbuminuric diabetic subjects in the early stages of CKD. Such strategy may help to improve risk stratification in diabeticpatients and guide therapeutic decisions during the early stages of the disease.
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