Salvatore Di Paolo1, Marco Fiorentino2, Luca De Nicola3, Gianpaolo Reboldi4, Loreto Gesualdo5, Federica Barutta6, Andrea Natali7, Giuseppe Penno8, Paola Fioretto9, Giuseppe Pugliese10. 1. Nephrology Unit, "Mons. Dimiccoli" Hospital Barletta, Italy. Electronic address: salvatoredipaolo@libero.it. 2. Nephrology Unit, "Mons. Dimiccoli" Hospital Barletta, Italy. 3. Nephrology and Dialysis Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. 4. Department of Medicine, University of Perugia, Perugia, Italy. 5. Department of Emergency and Organ Transplantation, "Aldo Moro" University, Bari, Italy; Nephrology, Dialysis and Transplantation Unit, "Policlinico" University Hospital, Bari, Italy. 6. Department of Medical Sciences, University of Turin, Turin, Italy. 7. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Unit of Internal Medicine, University Hospital, Pisa, Italy. 8. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Diabetes Unit, University Hospital, Pisa, Italy. 9. Department of Medicine, University of Padua, Padua, Italy; Unit of Medical Clinic 3, Hospital of Padua, Padua, Italy. 10. Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Endocrine and Metabolic Unit, Sant'Andrea University Hospital, Rome, Italy.
Abstract
AIMS: This joint document of the Italian Society of Nephrology and the Italian Diabetes Society reviews the main indications to perform a renal biopsy in diabetic patients, according to the recommendations of a panel of experts based on all available scientific evidence. DATA SYNTHESIS: Renal biopsy has a pivotal role in assessing the nature and severity of renal injury in patients with diabetic kidney disease (DKD). The procedure is mandatory in the presence of one of more of the following features: rapid onset or progression of albuminuria or sudden onset of nephrotic syndrome, rapid GFR decline with or without albuminuria, hematuria, active urine sediment, clinical and/or laboratory suspicion of other systemic diseases, and, in patients with type 1 diabetes, short diabetes duration and absence of retinopathy. Indeed, ~40% of diabetic individuals with kidney injury undergoing renal biopsy are affected by a non-diabetic renal disease (NDRD). Furthermore, the histological evaluation of patients with suspected classical diabetic nephropathy allows to define the extent of glomerular, tubulo-interstitial and vascular lesions, thus providing important prognostic (and potentially therapeutic) data. In the future, the indications for renal biopsy might be extended to the definition of the histological lesions underlying the "nonalbuminuric" DKD phenotypes, as well as to the evaluation of the response to treatment with the new anti-hyperglycemic drugs that provide cardiorenal protection. CONCLUSIONS: In view of the heterogeneous clinical presentation and course of DKD and of the related heterogeneous histopathological patterns, a more extensive use of renal biopsy may be crucial to provide valuable information with important pathogenic, diagnostic, prognostic, and therapeutic implications.
AIMS: This joint document of the Italian Society of Nephrology and the Italian Diabetes Society reviews the main indications to perform a renal biopsy in diabeticpatients, according to the recommendations of a panel of experts based on all available scientific evidence. DATA SYNTHESIS: Renal biopsy has a pivotal role in assessing the nature and severity of renal injury in patients with diabetic kidney disease (DKD). The procedure is mandatory in the presence of one of more of the following features: rapid onset or progression of albuminuria or sudden onset of nephrotic syndrome, rapid GFR decline with or without albuminuria, hematuria, active urine sediment, clinical and/or laboratory suspicion of other systemic diseases, and, in patients with type 1 diabetes, short diabetes duration and absence of retinopathy. Indeed, ~40% of diabetic individuals with kidney injury undergoing renal biopsy are affected by a non-diabetic renal disease (NDRD). Furthermore, the histological evaluation of patients with suspected classical diabetic nephropathy allows to define the extent of glomerular, tubulo-interstitial and vascular lesions, thus providing important prognostic (and potentially therapeutic) data. In the future, the indications for renal biopsy might be extended to the definition of the histological lesions underlying the "nonalbuminuric" DKD phenotypes, as well as to the evaluation of the response to treatment with the new anti-hyperglycemic drugs that provide cardiorenal protection. CONCLUSIONS: In view of the heterogeneous clinical presentation and course of DKD and of the related heterogeneous histopathological patterns, a more extensive use of renal biopsy may be crucial to provide valuable information with important pathogenic, diagnostic, prognostic, and therapeutic implications.