Jyh-Tong Hsieh1, Fu-Pang Chang2,3, An-Hang Yang2,3,4, Der-Cherng Tarng3,4,5,6,7, Chih-Yu Yang8,9,10,11,12. 1. Division of Nephrology, Department of Medicine, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan. 2. Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan. 3. School of Medicine, National Yang-Ming University, Taipei, Taiwan. 4. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. 5. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 6. Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, Taiwan. 7. Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan. 8. School of Medicine, National Yang-Ming University, Taipei, Taiwan. cyyang3@vghtpe.gov.tw. 9. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. cyyang3@vghtpe.gov.tw. 10. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. cyyang3@vghtpe.gov.tw. 11. Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, Taiwan. cyyang3@vghtpe.gov.tw. 12. Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan. cyyang3@vghtpe.gov.tw.
Abstract
BACKGROUND: Diabetic nephropathy (DN) is the most prevalent cause of renal disease in type 2 diabetic patients and is usually diagnosed clinically. A kidney biopsy is considered when non-diabetic renal disease (NDRD) is suspected, such as rapid progression in renal function impairment and severe proteinuria. Still, there is yet no consensus on the timing of kidney biopsy in type 2 diabetic patients. This study aims to identify markers that can help differentiate between DN and NDRD and guide the decision of kidney biopsy. METHODS: We retrospectively reviewed patients with type 2 diabetes who received kidney biopsy from 2008 to 2017 at Taipei Veterans General Hospital. Ophthalmologist consultation and outpatient records, diagnosis of kidney biopsy, laboratory data, and clinical characteristics were collected. RESULTS: This study enrolled 160 type 2 diabetic patients, among which 120 (75%) had isolated DN and 40 (25%) had NDRD ± DN (26 had isolated NDRD, and 14 had NDRD superimposed on DN). In multivariate logistic regression analysis, DM duration (odds ratio [OR]: 0.907; 95% confidence interval [CI]: 0.842-0.977; P = 0.01), diabetic retinopathy (OR: 0.196; 95% CI: 0.061-0.627; P = 0.006), and urinary RBC (OR: 1.068; 95% CI: 1.024-1.115; P = 0.002) were independent predictors of NDRD. In patients with diabetic retinopathy (n = 112, 70%), the presence of proliferative diabetic retinopathy, pan-retinal photocoagulation, and hematuria were factors predicting NDRD; and in patients without diabetic retinopathy (n = 48, 30%), short DM duration and hematuria were factors predicting NDRD. CONCLUSIONS: Using diabetic retinopathy, DM duration, and hematuria, we developed a 3-step approach to stratify patients into three categories with the different likelihoods of having NDRD. Then different strategies could be taken accordingly. Our stepwise approach is easy to follow and may serve as an appropriate and useful tool to help clinicians in making decisions of kidney biopsy in type 2 DM patients presenting with kidney diseases.
BACKGROUND:Diabetic nephropathy (DN) is the most prevalent cause of renal disease in type 2 diabeticpatients and is usually diagnosed clinically. A kidney biopsy is considered when non-diabetic renal disease (NDRD) is suspected, such as rapid progression in renal function impairment and severe proteinuria. Still, there is yet no consensus on the timing of kidney biopsy in type 2 diabeticpatients. This study aims to identify markers that can help differentiate between DN and NDRD and guide the decision of kidney biopsy. METHODS: We retrospectively reviewed patients with type 2 diabetes who received kidney biopsy from 2008 to 2017 at Taipei Veterans General Hospital. Ophthalmologist consultation and outpatient records, diagnosis of kidney biopsy, laboratory data, and clinical characteristics were collected. RESULTS: This study enrolled 160 type 2 diabeticpatients, among which 120 (75%) had isolated DN and 40 (25%) had NDRD ± DN (26 had isolated NDRD, and 14 had NDRD superimposed on DN). In multivariate logistic regression analysis, DM duration (odds ratio [OR]: 0.907; 95% confidence interval [CI]: 0.842-0.977; P = 0.01), diabetic retinopathy (OR: 0.196; 95% CI: 0.061-0.627; P = 0.006), and urinary RBC (OR: 1.068; 95% CI: 1.024-1.115; P = 0.002) were independent predictors of NDRD. In patients with diabetic retinopathy (n = 112, 70%), the presence of proliferative diabetic retinopathy, pan-retinal photocoagulation, and hematuria were factors predicting NDRD; and in patients without diabetic retinopathy (n = 48, 30%), short DM duration and hematuria were factors predicting NDRD. CONCLUSIONS: Using diabetic retinopathy, DM duration, and hematuria, we developed a 3-step approach to stratify patients into three categories with the different likelihoods of having NDRD. Then different strategies could be taken accordingly. Our stepwise approach is easy to follow and may serve as an appropriate and useful tool to help clinicians in making decisions of kidney biopsy in type 2 DMpatients presenting with kidney diseases.
Authors: Seunghye Lee; Sehyun Jung; Mi-Ji Kim; Jong Sil Lee; Ha Nee Jang; Se-Ho Chang; Hyun-Jung Kim Journal: Medicine (Baltimore) Date: 2022-07-22 Impact factor: 1.817