Introduction:
Clinically indicated kidney biopsies in diabetic patients are generally performed when the presentation suggests the possibility of conditions other than diabetic kidney disease (DKD). Suspicious indicators include sudden onset proteinuria occurring within less than five years from the onset of type 1 diabetes, proteinuria in the absence of retinopathy (especially in type 1 diabetes) or neuropathy, acute kidney injury, active urinary sediment, or hematuria. Consequently, it is not surprising to find a high incidence of non-diabetic kidney disease (NDKD) in clinical biopsies from diabetic patients. Aim of Study: To study the prevalence and clinical predictors of NDKD in patients with type 2 diabetes mellitus.
Methods:
This cross-sectional observational study was conducted at Dayanand Medical College and Hospital in Ludhiana. Patients with diabetes suspected of having non-diabetic renal disease (NDRD) underwent kidney biopsy after informed consent based on specific criteria, either alone or in combination: hematuria (red blood cells >5 per high power field, red blood cell casts), sudden increases in serum creatinine by more than 2 mg/dL, sudden onset of nephrotic syndrome, renal failure in the absence of diabetic retinopathy (DR), duration of diabetes mellitus (DM) less than five years, massive proteinuria (nephrotic range) with normal renal function, or significant renal insufficiency (serum creatinine >2 mg/dL) with normal or insignificant proteinuria (<500 mg/dL).
Results:
The most frequent NDKD observed was acute interstitial nephritis (AIN) at 12%, followed by IgA nephropathy, crescentic glomerulonephritis, and focal proliferative glomerulonephritis, each accounting for 7%. The most common pathology observed in mixed renal disease was diabetic nephropathy (DN) combined with AIN. The duration of hypertension in patients with non-diabetic kidney disease was 4.98 ± 2.86 years, compared to 8.07 ± 4.65 years in those with DKD, which was statistically significant. A shorter duration of DM (less than five years) was seen in a greater number of patients in the NDKD group compared to the DKD group. Conversely, a DM duration of more than ten years was more frequently seen in the DKD group. Additionally, the DKD group had a higher number of patients with non-proliferative diabetic retinopathy (NPDR) compared to the NDKD group.
Conclusions:
This study demonstrates the importance of early suspicion and diagnosis of non-diabetic kidney disease (NDKD) in diabetic patients, as various pathologies like membranous nephropathy (MN), IgA nephropathy, and AIN are typically manageable or even curable.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.