Abstract
Background: The high frequency of diabetes mellitus (DM) means that patients with DM may have other nephropathies.
Purpose: to describe the prevalence and histopathological lesions in renal biopsies (RB) of patients with DM of more than one year of diagnosis.
Methodology: diabetics followed in a renal health program (1985-2020) with RB during that period were included (age ? 15 years, DM ? 1 year before RB).
Results: 190 RB were analyzed, from patients with DM of 8 (1-24) years of evolution, 2.63% with retinopathy. The number of RB in DM was increasing over time in our country. The indication for RB was asymptomatic urinary alterations (AUA) (39%), nephrotic syndrome (NS) (28.4%), rapidly progressive renal failure (11.6%), and chronic kidney disease (CKD) (11%). They had a pattern of diabetic nephropathy (DN) 11%. The main patterns of non-diabetic nephropathy (NND) (89%) were: segmental and focal sclerohyalinosis (SFSH) (22.63%), membranous (14.21%), vasculitis (12.63%), and IgA (7.36%). Patients with DN presented with NS (52.4%) and AUA (19%). Those with NND and NS had SFSH (27.3%) and membranous (23.6%), those with AUA had SFSH (24.1%), vasculitis (13.9%), and IgA (13.9%), and those with CKD had SFSH (20%) and nephroangiosclerosis (16%). The distribution of lesion patterns in the NND group was similar to the general population without DM.
Conclusions: RB is indicated with increasing frequency in diabetic patients, the main indications in our series were NS and AUA. A low percentage had only DN lesions and the distribution of lesions in patients with NND was similar to that of the adult population without DM.
References
Ministerio de Salud Pública. 2.a Encuesta Nacional de Factores de Riesgo de Enfermedades No Transmisibles. Ministerio de Salud Pública; 2013.
Nanda M, Sharma R, Mubarik S, Aashima A, Zhang K. Type-2 diabetes mellitus (T2DM): spatial-temporal patterns of incidence, mortality and attributable risk factors from 1990 to 2019 among 21 world regions. Endocrine. 2022;77(3):444-54. https://doi.org/10.1007/s12020-022-03125-5
González-Bedat MC, Luzardo L, Oroza V, Ceretta ML, Silvariño R, Ferreiro A. Registro uruguayo de diálisis [informe anual]. Montevideo, Uruguay: Sociedad Uruguaya de Nefrología, Fondo Nacional de Recursos, Centro de Nefrología-Hospital de Clínicas-Udelar; 2019. https://www.nefrologia.hc.edu.uy/images/INFORME_2019_FINAL_1.pdf
Garau M, Cabrera J, Ottati G, Caorsi H, Gonzalez Martinez F, Acosta N, et al. Temporal trends in biopsy proven glomerular disease in Uruguay, 1990-2014. PLoS One. 2018;13(10):e0206637. https://doi.org/10.1371/journal.pone.0206637
Chen Y, Lee K, Ni Z, He JC. Diabetic kidney disease: challenges, advances, and opportunities. Kidney Dis. 2020;6(4):215-25. https://doi.org/10.1159/000506634
Mazzucco G, Bertani T, Fortunato M, Bernardi M, Leutner M, Boldorini R, et al. Different patterns of renal damage in type 2 diabetes mellitus: a multicentric study on 393 biopsies. Am J Kidney Dis. 2002;39(4):713-20. https://doi.org/10.1053/ajkd.2002.31988
Serra A, Romero R, Bayés B, Lopez D, Bonet J. Is there a need for changes in renal biopsy criteria in proteinuria in type 2 diabetes? Diabetes Res Clin Pract. 2002;58(2):149-53. https://doi.org/10.1016/s0168-8227(02)00131-6
Castellano I, Novillo R, Gómez-Martino JR, Ferrando L, Covarsi A. Lesiones histológicas renales en pacientes con diabetes mellitus tipo II. Nefrología. 2002;22(2):162-9.
Izzedine H, Fongoro S, Pajot O, Beaufils H, Deray G. Retinopathy, hematuria, and diabetic nephropathy. Nephron. 2001;88(4):382-3. https://doi.org/10.1159/000046025
Zhang PP, Ge YC, Li SJ, Xie HL, Li LS, Liu ZH. Renal biopsy in type 2 diabetes: timing of complications and evaluating of safety in Chinese patients. Nephrology. 2011;16(1):100-5. https://doi.org/10.1111/j.1440-1797.2010.01369.x
Zhuo L, Ren W, Li W, Zou G, Lu J. Evaluation of renal biopsies in type 2 diabetic patients with kidney disease: a clinicopathological study of 216 cases. Int Urol Nephrol. 2013;45:173-9. https://doi.org/10.1007/s11255-012-0164-6
Sharma SG, Bomback AS, Radhakrishnan J, Herlitz LC, Stokes MB, Markowitz GS, et al. The modern spectrum of renal biopsy findings in patients with diabetes. Clin J Am Soc Nephrol. 2013;8(10):1718-24. https://doi.org/10.2215/cjn.02510213
Biesenbach G, Bodlaj G, Pieringer H, Sedlak M. Clinical versus histological diagnosis of diabetic nephropathy--is renal biopsy required in type 2 diabetic patients with renal disease? QJM. 2011;104(9):771-4. https://doi.org/10.1093/qjmed/hcr059
Rychlík I, Jan?ová E, Tesa? V, Kolský A, Lácha J, Stejskal J, et al. The Czech registry of renal biopsies. Occurrence of renal diseases in the years 1994-2000. Nephrol Dial Transplant. 2004;19(12):3040-9. https://doi.org/10.1093/ndt/gfh521
Tone A, Shikata K, Matsuda M, Usui H, Okada S, Ogawa D, et al. Clinical features of non-diabetic renal diseases in patients with type 2 diabetes. Diabetes Res Clin Pract. 2005;69(3):237-42. https://doi.org/10.1016/j.diabres.2005.02.009
Pham TT, Sim JJ, Kujubu DA, Liu ILA, Kumar VA. Prevalence of nondiabetic renal disease in diabetic patients. Am J Nephrol. 2007;27(3):322-8. https://doi.org/10.1159/000102598
Chang TI, Park JT, Kim JK, Kim SJ, Oh HJ, Yoo DE, et al. Renal outcomes in patients with type 2 diabetes with or without coexisting non-diabetic renal disease. Diabetes Res Clin Pract. 2011;92(2):198-204. https://doi.org/10.1016/j.diabres.2011.01.017
Bi H, Chen N, Ling G, Yuan S, Huang G, Liu R. Nondiabetic renal disease in type 2 diabetic patients: a review of our experience in 220 cases. Ren Fail. 2011;33(1):26-30. https://doi.org/10.3109/0886022x.2010.536292
Oh SW, Kim S, Na KY, Chae DW, Kim S, Jin DC, et al. Clinical implications of pathologic diagnosis and classification for diabetic nephropathy. Diabetes Res Clin Pract. 2012;97(3):418-24. https://doi.org/10.1016/j.diabres.2012.03.016
Sanghavi SF, Roark T, Zelnick LR, Najafian B, Andeen NK, Alpers CE, et al. Histopathologic and clinical features in patients with diabetes and kidney disease. Kidney360. 2020;1(11):1217-25. https://doi.org/10.34067/kid.0003962020
Fernández C, Acosta N, Caorsi H, Mazzuchi N. Glomerulopatía no diabética en diabéticos tipo 2. Libro de Resúmenes del VII Congreso Uruguayo de Nefrología; 2011.
Luna D, Lorenzo MJ, Guadalupe M, Rabazza V, Ríos P, Aunchaubya H, et al. Hallazgos en biopsias renales de pacientes diabéticos. Libro de resúmenes del IX Congreso Uruguayo de Nefrología; 2015.
KDIGO. Notice. Kidney Int Suppl. 2013;3(1). https://doi.org/10.1038/kisup.2012.73
KDIGO. Notice. Kidney Int Suppl. 2012;2(1). https://doi.org/10.1038/kisup.2012.1

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.