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Diabetic kidney disease is typically diagnosed clinically, however, diabetic nephropathy is a histopathological diagnosis. Non-diabetic nephropathy can be found in diabetic patients, which has increased due to the high incidence of diabetes mellitus in the general population and the tendency to perform renal biopsies.
Describe the clinical and histological characteristics of diabetic patients with renal disease and their progression over 6 months. Analytical, retrospective study of patients with diabetes mellitus who underwent renal biopsy from 2016 to 2023.
A total of 61 patients with a diagnosis of diabetes mellitus were analyzed and divided into two groups based on histopathological findings (Table 1).
52.5% (32) had Nodular diabetic glomerulosclerosis (NDG), of which 50% (16) had an additional glomerular lesion pattern, mainly Focal and segmental glomerulosclerosis (FSGS) in 93.7% (15), with a predominance of the tip type. 62.5% had Tubulointerstitial Nephritis (TIN), and 15.6% had Thrombotic Microangiopathy (TMA).
At 6 months, a better response was observed in the group with glomerular disease without NDG nephropathy (p=0.01), with stable glomerular filtration rate, patients with NDG presented greater progression to CKD (p=0.003) regardless of glycemic control, without difference in levels of albuminuria and proteinuria.
Better renal prognosis was observed in diabetic patients with glomerular disease but without diabetic nodular nephropathy, possibly due to the presence of TIN and TMA with NDG. NDG is associated with a longer duration of diabetes mellitus, emphasizing the importance of better control and monitoring. Renal biopsy is essential in these patients due to the high incidence of non-diabetic nephropathy, allowing for timely treatment and prevention of kidney disease progression.
Variables
DM with Nodular diabetic glomerulosclerosis (32)
DM with GD
Patients (number)
DM with NDG (16)
DM With NDG and GD (16)
(29)
Age (Years)
49.5 (±10.3)
46.6 (±11.8)
53.9 (±12.5)
Female
Male
62.5%
37.5%
43.7%
56.3%
58%
42%
Diagnosis time (Average)
11.9 (±6.4)
14.5 (±9.3)
7.1 (±7.9)
BMI
27.9 (±3.2)
27 (±2.2)
26.9 (±4.4)
SAH
68.7%
81.2%
62%
Autoinmunity
6.2%
17%
Nephrotic proteinuria
75%
51.7%
Subnephrotic proteinuria
12.5%
27.5%
Nephritic
18.7%
10.3%
AKI
Proteinuria mg/24 hours
5639 (±3641)
5476 (±3790)
3487 (±3078)
Albuminuria mg/24 hours
2062 (±1571)
2852 (±1906)
1934 (±2127)
serum albumin
3.2 (±0.5)
3.16 (±0.5)
3.2 (±0.9)
GFR ml/hr
39.5 (±23)
49 (±33)
60 (±41)
Creatinine mg/dl
2.6 (±1.8)
2.6 (±2.3)
2.3 (±2.4)
Hb1AC %
7.7 (±1.7)
7 (±2)
7.1 (±1.8)
Fasting blood glucose
158 (±79)
126 (±85)
118 (±49)
Class RPS III
NA
TIN
56.2%
34.4%
TMA
25%
0%
RAAS blockade
93.7%
100%
93.2%
Insulin use
Oral hypoglycemic agent
31.2%
31%
Using iSGLT2
20.5%
Immunosuppression
72.4%
Table 1: DM: Diabetes Mellitus, GD: Glomerular Disease, NDG: Nodular Diabetic glomerulosclerosis AKI: Acute Kidney Injury, GFR: glomerular filtration rate, BMI: Body mass Index, SAH: Systemic Arterial Hypertension, TIN: Tubulointerstitial Nephritis, TMA: Thrombotic Microangiopathy.