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Diabetic kidney disease (DKD) is world over one of the leading causes of chronic kidney disease. The presence of coexistent non-diabetic renal pathology (CNDRP) with DKD may complicate already undergoing DKD leading to faster decline in renal functions. The diagnosis of CNDRP and its early management can reduce the associated morbidity and mortality.
The aim was to study the spectrum of CNDRP in patients with biopsy proven DKD. Total of 145 patients were identified having biopsy proven DKD from a period of January 2018 to March 2022 at tertiary care center in North India. The renal biopsies along with clinical details were evaluated for the presence of CNDRP lesions and compared their clinical and laboratory parameters with isolated DKD patients.
Mean age was 53.7 years in 54 (37.2%) CNDRP patients as compared to 51.7 years in 91 isolated DKD patients. Commonest indication of renal biopsy in both groups was heavy proteinuria. Median S creatinine in isolated DKD and CNDRP were 2.4 and 4.0 mg/dL respectively and was significantly higher in CNDRP patients (p= 0.02).
The percentage of DKD Tervaert class I, II, III and IV were 6.9%, 22.1%, 29.6% and 41.4% respectively in renal biopsy. The most commonly diagnosed CNDRP in biopsies was tubulointerstitial nephritis (TIN) in 17 (31.5%) followed by acute tubular injury (ATI) in 9 and FSGS in 6 (11.1%) patients. Infection related glomerulonephritis (IRGN), IgAN, C3GN and hypertensive nephropathy (4 patients in each group); membranoproliferative GN in 2 patients; and membranous nephropathy (MN), mesangioproliferative GN, fibrillary GN and cast nephropathy (1 patient in each group) were present.
Patients were managed for the CNDRP apart from glycemic control medication. CNDRP with DKD hastens the decline of renal functions requiring prompt management. The early diagnosis of CNDRP in renal biopsy helps in early initiation of treatment and better preservation of renal functions for a longer period.