CLINICAL PROFILE OF NON DIABETIC KIDNEY DISEASE IN THE RENAL BIOPSIES OF DIABETES MELLITUS PATIENTS

Introduction:

Diabetic nephropathy is the leading cause of end-stage kidney disease worldwide. Diabetic nephropathy is not the only form of renal disease in patients with diabetes mellitus, but other non-diabetic renal diseases can occur. The timely diagnosis of non-diabetic renal disease is of great importance for early and appropriate treatment of patients, which can significantly slow down the progression to chronic kidney disease. Many forms of non-diabetic kidney disease can be successfully treated (e.g. glomerulonephritis with immunosuppressives therapy), in contrast to diabetic nephropathy which has a progressive course.

Methods:

This is a retrospective study in which we collected the clinical profile of patients who had type 2 diabetes mellitus and underwent renal biopsy for conventional indications from January 2023 to August 2024. We collected the clinical data of 72 patients who were biopsied during this period.

Results:

1. Out of the 72 patients who underwent renal biopsy, 47 patients (65.2%) were males. 2. Mean age of presentation being 49.29 ± 10.19 years. 3. Mean of the duration of diabetes mellitus in the study population was 6.77± 4.05 years. 4. Coexistence of hypertension was present in almost 56 patients (77.77%) the mean duration of hypertension in these patients were 3.04 ±3.82 years. 5. New onset hypertension was present in 16 patients (22.22%).On analysing the associated microvascular complications in the study population ; diabetic neuropathy was present 27 patients (37.5%) which was confirmed by clinical examination and nerve conduction tests. 6. Diabetic retinopathy (27.77%)-non proliferative diabetic retinopathy was present in 12 patients (16.66%); proliferative diabetic retinopathy was present in 8 patients (11.11%) 7. Indication for renal biopsy : nephrotic range proteinuria in 20 patients (27.77%)and rapidly progressive renal failure (RPRF) in 52 (72.77%)patients 8. 8.The analysis of complements pattern in these patients were classified as I. C3 ,C4 normal (46 patients, 63.88%) II. C3 low ,C4 normal (22 patients,30.55%) III. Both C3 low (4 patients,5.55%) .Patients with fall in glomerular filtration rate (GFR) Out of 72 patients ,56 patients (77.7%) had fall in GFR Which was further estimated roughly into 3 categories. I. Creatinine at presentation- 0-1mg/dl- 10 patients(13.8%) II. 1-5mg/dl-24 patients (33.33%) III. >5mg/dl – 38 patients (52.7%) 10.Biopsy findings in the study population. 26 patients (36.11%) had infection related glomerulonephritis(IRGN),out of which 1 patient had IgA dominant IRGN,and 1 patient had Thrombotic microangiopathy with patchy cortical necrosis with IRGN.16 patients (22.22%) had isolated diabetic nephropathy.7 patients (0.1%) had acute interstitial nephritis (AIN). 4 patients (0.055%) had membranous nephropathy, out of which 2 patients had PLA2R (phospholipase A2 receptor antibody) positive membranous nephropathy. In these patients with primary membranous glomerulonephritis, immunosuppressives therapy with cyclophosphamide and prednisolone was administered and partial disease remission with preserved renal function was achieved. 4 patients (0.055%) had lupus nephritis – out of which 2 patients had class 4 lupus nephritis (Renal pathological society classification) ,1 patient with class 5 and 1 patient had class 3 lupus nephritis. 4 patients (0.055%) had global glomerular sclerosis with severe IFTA 3 patients (0.04%) had IgA nephropathy . 2 patients (0.027%) had focal segmental glomerulosclerosis (FSGS). 2 patients had acute tubulointerstitial nephritis (0.027%) 1 patient had collapsing glomerulopathy,1 with light chain cast nephropathy, 1 patient with crescentic pauci-immune glomerulonephritis ,1 patient had minimal change disease . Out of these 16 patients , who had diabetic nephropathy 12 patients are dialysis dependant. All 4 patientswith global glomerulosclerosis with severe IFTA are dialysis dependant. Out of 26 patients who had IRGN ,8 (33.3%) patients out of the 26 patients are dialysis dependant. Totally, out of 72 patients ,34 (47%) patients are dialysis dependant.

Conclusions:

Non diabetic kidney disease accounts for two-thirds of patients with diabetes mellitus. Immunosuppressive therapy in patients with Lupus nephritis ,Membranous nephropathy,Focal segmental glomerulosclerosis was successful and resulted in partial or complete disease remission. Approximately half of the study population had dialysis dependant renal failure. This supports that the diagnosis of non-diabetic kidney disease by kidney biopsy enables the implementation of disease specific therapy and thus significantly influences the course and outcome of the disease.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.