Risk factors for diabetic kidney diseases in inpatients with type 2 diabetes / 中华内分泌代谢杂志

Objective To analyze risk factors for diabetic kidney disease (DKD) in inpatients with type 2 diabetes.Methods A total of 930 inpatients with type 2 diabetes were enrolled in the study and grouped according to different levels of estimated glomerular filtration rate (eGFR),albuminuria,and diabetic retinopathy.Logistic regression analysis was adopted to explore the risk factors for DKD in inpatients with type 2 diabetes.Results (1) The prevalence of albuminuria in patients with type 2 diabetes mellitus was increased with declining eGFR (P ＜ 0.05).(2) The prevalences of DKD and non-diabetic renal disease (NDRD) in patients with type 2 diabetes mellitus were 22.26％ and 8.92％,respectively.Compared with patients with NDRD,patients with DKD had longer diabetic duration,higher levels of systolic blood pressure,serum creatinine,and urinary albumin excretion,and lower levels of hemoglobin[(125.40 ± 21.95 vs 138.18 ± 19.67) g/L],serum albumin[(37.45 ± 5.54 vs 40.55 ± 3.55) g/L],and eGFR[(89.66 (59.10-108.25) vs 103.15 (85.39-114.88) ml · min-1 · (1.73 m2)-1,all P＜0.05].(3) Logistic regression analysis showed that age,diabetic duration,systolic blood pressure,serum uric acid,diabetic retinopathy,and hypertension are the independent risk factors for diabetic kidney disease in inpatients with type 2 diabetes,while serum albumin was the protective factor (all P＜0.01).Conclusions A variety of clinic risk factors were associated with DKD.Better control of blood pressure,serum uric acid,and hypoalbuminemia should be performed to delay the progress of DKD.

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

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.

Clinical Characteristics of Non-diabetic Renal Disease in Type 2 Diabetic Patients / 대한신장학회잡지

BACKGROUND: Non-diabetic renal diseases are accompanied in 9-66% of type 2 diabetic patients and some clinical and laboratory findings are known as predictors of these non-diabetic renal disease. In Korea, however, there have been few studies on the clinical and pathologic findings of non-diabetic renal disease in diabetic patients. The purpose of this study was to explore the clinical, laboratory, and pathologic features of non-diabetic renal disease and to clarify the factors that could predict non-diabetic renal disease in type 2 diabetic patients. METHODS: The medical records of type 2 diabetic patients who were over 20 years old and underwent renal biopsy between January, 1994 and December, 2003, were retrospectively reviewed. RESULTS: A total of 56 patients were enrolled. Persistent hematuria (25.0%) was the leading reason for renal biopsy in type 2 diabetic patients, followed by sudden onset of nephrotic-range proteinuria (23.2 %), short duration (<10 years) of DM (23.2%), rapid deterioration of renal function (17.9%), and absence of diabetic retinopathy (8.9%). Renal biopsy revealed diabetic nephropathy (DN) in 20 patients (35.7%), non-diabetic renal disease (NDRD) in 33 patients (58.9%), and NDRD with concomitant DN in 3 patients (5.4%). The most common NDRD was membranous nephropathy, accompanied in 9 patients (16.1 %), followed by minimal change disease (10.7%), focal segmental glomerulosclerosis (8.9%). When the patients were divided into DN (20 patients) and NDRD (36 patients) groups, NDRD group had significantly shorter duration of DM, more patients with hematuria, and less patients with DM retinopathy. In contrast, there were no differences in age, sex, blood pressure, blood urea nitrogen, serum creatinine, albumin, and total cholesterol levels, 24 hr urinary protein and albumin excretion, creatinine clearance, and proportion of patients with DM neuropathy between the two groups. CONCLUSION: There were significant differences in the duration of DM, the presence of hematuria, and the presence of retinopathy between DN and NDRD groups. Therefore, we must consider NDRD in type II DM patients with short duration of DM, hematuria or without retinopathy.

Minimal Change Nephrotic Syndrome in a Patient with Type II Diabetic Mellitus and Review of the Literature / 대한신장학회잡지

Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria, a relentless decline in GFR and raised arterial blood pressure, and usually diagnosed on clinical grounds without a renal biopsy. Their renal injuries are irreversible and they become eventually end-stage renal disease. Recently, it has been reported that proteinuria are also induced by other causes, and some of the renal diseases was treatable. The detection of non-diabetic renal disease in diabetic patients by renal biopsy has the prognostic and therapeutic importance. We report a case of type II diabetic mellitus with minimal change nephrotic syndrome, and no evidence of diabetic glomerulosclerosis.

Non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus

The diagnosis of diabetic nephropathy (DN) is almost always based on clinical grounds. The diagnosis is supported by a long history of diabetes, evidence of target organ damage and proteinuria preceding azotemia. The validity of this clinical approach is well established in insulin dependent diabetes mellitus but not in non-insulin dependent diabetes mellitus (NIDDM). It is thus important to determine which patients with NIDDM accompanied by non-diabetic renal disease (NDRD) should have a biopsy. However, factors clinically associated with NDRD in patients with NIDDM remain unclear. Therefore we reviewed clinical data, laboratory data and renal biopsies from 22 NIDDM patients who underwent renal biopsy between 1992 and 1998 in Wonju Christian Hospital. From this data, we identified important features that would discriminate between DN and NDRD. There were 8 women and 14 men. Age ranged from 33 to 68 (51.2 +/- 10.7) years. The duration of diabetes at biopsy ranged from 0 to 13 (4.2 +/- 4.2) years. Nephrotic syndrome was present in 13 patients. The patients with NDRD (n = 14) and DN (n = 8) had comparable 24-hour proteinuria, 24-hour albuminuria, creatinine clearance, serum creatinine, albumin, as well as incidences of neuropathy and hypertension. The significant factors that predict the NDRD included a short duration of the diabetes mellitus, the presence of dysmorphic red blood cells in urine, the absence of retinopathy and HbA1c below 9% (p < 0.05, respectively). NDRD included IgA nephropathy (n = 6), minimal change disease (n = 3), membranous nephropathy (n = 3), membranous lupus nephritis (n = 1) and acute interstitial nephritis (n = 1). Multiple logistic regression analysis revealed that the short duration of DM and the absence of retinopathy were factors significantly associated with NDRD. In summary, when there is a short duration of diabetes mellitus, or an absence of retinopathy seen in patients with NIDDM, then renal biopsy in diabetic patients aids in the detection of NDRD.