THE SPECTRUM OF RENAL BIOPSY FINDINGS IN PATIENTS WITH DIABETES.

8 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-3278, Poster Board= SAT-064

Introduction:

THE SPECTRUM OF RENAL BIOPSY FINDINGS IN PATIENTS WITH DIABETES.

Methods:

This is a retrospective study of renal biopsies in 224 diabetic patients, who were admitted in Gandhi Medical College from January 2022 to  January 2024 included in the study.

Results:

Key Demographic and clinical Data at the time of biopsy.

 

Charecteristics

DN alone

DN plus NDRD

NDRD alone

Participants

78

64

82

AGE

58(48-64)

62(56-73)

61(55-72)

DM Type 1

6

4

4

Duration of DM

14(9-18)

11(6-19)

6(4-12)

Serum creatinine mg/dl

2.4(1.5-3.7)

3.2(1.6-5.3)

2.4(1.6-4.4)

Egfr ml/min per 1.73 m2

31.2(17.5-55.2)

22.6(12.6-46.8)

32.6(14.4-60)

Proteinuria (g/d)

5.0(2.8-8.8)

5.0(2-8)

2.9(1.4-7.1)

Summary of NDRD with and without DN, found on biopsies of patients with diabetes

Types of NDRD

NDRD Alone  (n= 82)

DN PLUS NDRD(n=64)

P value

Acute tubular necrosis

17

20

0.001

PRIMARY FSGS

4

2

0.008

SECONDARY FSGS-HTN/OBESITY

2

4

0.003

HYPERTENSIVE NEPHROSCLEROSIS

21

14

0.001

IGA NEPHROPATHY

12

6

0.004

MEMBRANOUS NEPHROPATHY

8

4

0.004

PAUCI IMMUNE

2

2

0.006

ACUTE INTERSTITIAL NEPHRITIS

2

3

0.004

AMYLOIDOSIS

2

3

0.006

MYELOMA CAST

1

1

0.004

PIGN

11

5

0.002

Reported indications and notable laboratory values in patients with diabetes who underwent kidney biopsy

 

Variables

DN alone

DN plus NDRD

NDRD alone

Patients(n)

78

64

82

Proteinuria(mg/d)

 

 

 

<500

8

4

10

500-3500

29

27

39

>3500

31

33

33

Active urine sediment

24

26

29

AKI(baseline no CKD)

38

31

40

AKI( baseline CKD)

16

17

22

All AKI

42

36

45

Any positive serologic test

23

25

31

[+]Ana, ds DNA , or cardiolipin antibody

14

16

12

[+] ANCA

2

5

7

Low C3 and /or C4

1

4

6

[+] HBsAg or HCV antibody

6

9

4

M-spike(serum or urine)

2

3

3

(+) HIV

1

3

2

Association of key clinical predictors and biopsy findings of nondiabetic renal disease

 

Variables

OR(95%CI)

P value

Proteinuria(mg/d)

 

 

<500

1.00(reference)

 

500-3500

1.28 (0.39 to 4.20)

0.68

>3500

0.55 (0.19 to 1.66

0.29

eGFR(ml/min per 1.73m2

 

 

>60

1.00 (reference)

 

30-60

0.89 (0.35 to 2.25)

0.81

15-30

1.42 (0.53 to 3.82)

0.49

<15

1.54 (0.48 to 4.96)

0.47

Age

1.03 (1.00 to 1.06)

0.06

Male sex

1.05 (0.54 to 2.02)

0.89

Duration of diabetes

0.95 (0.91 to 0.98)

0.004

AKI

1.44 (0.67 to 3.07)

0.35

Low complements

4.70 (0.49 to 45.42)

0.18

M-spike(serum or urine)

1.50 (0.51 to 4.37)

0.46

Conclusions:

1.In this cohort of 224 patients with DM, the largest study to date of renal biopsy findings in diabetic patients, NDRD was identified in >60% of biopsies: 82 patients with NDRD alone and 64 patients with NDRD and coexistent DN.

 

2. We found that duration of diabetes was the strongest predictor of whether NDRD or DN was identified on biopsy.

 

3.The median duration of DM in patients with NDRD alone was 5 years, which was significantly shorter than in patients with DN alone (13 years) and DN plus NDRD (10 years), and DM duration ≥12 years emerged as the best predictor of DN alone.

 

4. In addition, although the median proteinuria for the entire cohort was in the nephrotic range, heavier proteinuria was associated with a lower likelihood of finding NDRD alone.

5.Taken together, these results suggest that the diabetic patient who is most likely to have NDRD alone has a short duration of DM and subnephrotic proteinuria.

I have no potential conflict of interest to disclose.

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