Beyond Diabetic Kidney Disease: Histopathological Spectrum and Clinical Outcomes of Renal Biopsy in Patients with Diabetes Mellitus

 

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https://storage.unitedwebnetwork.com/files/1099/166c439fa48fb317c5d32965f0a02086.pdf
Beyond Diabetic Kidney Disease: Histopathological Spectrum and Clinical Outcomes of Renal Biopsy in Patients with Diabetes Mellitus

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Irma I.
Flores-Ponzio
Lesly A. Treviño-Partida leslyanette2200@gmail.com Hospital Universitario "Dr. José Eleuterio González" Department of nephrology Monterrey Mexico -
Mariana Erro-Gonzalez mariana_ergo@hotmail.com Hospital Universitario "Dr. José Eleuterio González" Department of nephrology Monterrey Mexico -
Irma I. Flores-Ponzio irmaflorespz24@gmail.com Hospital Universitario "Dr. José Eleuterio González" Department of nephrology Monterrey Mexico *
Jose F. Veliz-Escobar fidelveliz@ufm.edu Hospital Universitario "Dr. José Eleuterio González" Department of nephrology Monterrey Mexico -
Concepcion Sanchez-Martinez concepcion.sanchezm@uanl.edu.mx Hospital Universitario "Dr. José Eleuterio González" Department of nephrology Monterrey Mexico -
Giovanna Y. Arteaga-Müller giomuller@gmail.com Hospital Universitario "Dr. José Eleuterio González" Department of nephrology Monterrey Mexico -
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Diabetic kidney disease (DKD) remains the leading cause of chronic kidney disease worldwide. Nevertheless, non-diabetic renal diseases (NDRD) are frequently identified in patients with diabetes mellitus (DM), which has major diagnostic, therapeutic, and prognostic implications. The aim of this study was to describe the histopathological findings of renal biopsy in diabetic patients and to evaluate the clinical outcomes of those diagnosed with NDRD after tailored management. 

We performed a retrospective, descriptive study including 26 diabetic patients who had a renal biopsy performed at a tertiary care center in Northern Mexico between 2021 and 2025. The data were obtained from each patient’s medical record and included demographic characteristics, comorbidities, clinical presentation, histopathological diagnosis, and laboratory parameters at baseline and follow-up to 6 months. Clinical syndromes were classified as nephrotic syndrome, nephritic syndrome, or acute kidney injury. Patients with NDRD were followed to assess changes in renal function, hemoglobin concentration, and proteinuria. 

During follow-up of the 15 patients with NDRD, we observed significant clinical improvement after specific therapy: estimated glomerular filtration rate increased from 12.4 to 38.6 ml/min/1.73 m², serum creatinine decreased from 3.2 to 1.9 mg/dL, hemoglobin rose from 8.8 to 10.6 g/dL, and proteinuria markedly reduced from 1.9 g/24h to near remission. 

Renal biopsy in diabetic patients revealed that more than half had NDRD, challenging the assumption that renal dysfunction is invariably due to DKD. Importantly, individualized management based on histopathological diagnosis led to significant improvements in renal function, hemoglobin levels, and proteinuria. These findings underscore the pivotal role of renal biopsy as a tool for precision medicine, guiding therapeutic decisions, and improving prognosis in diabetic patients with atypical presentations or rapid progression of kidney disease. 

Kewords