Palabras clave
nefropatías
diabetes mellitus
albuminuria
biopsia con aguja
diabetes mellitus
albuminuria
biopsia con aguja
Cómo citar
1.
Aristizabal Gómez LY, Restrepo Valencia CA, Aguirre Arango JV. Características clínicas de una población de diabéticos tipo 2 con alteración en la función renal no macroalbuminúricos. Rev. Colomb. Nefrol. [Internet]. 27 de julio de 2017 [citado 3 de julio de 2024];4(2):149-58. Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/271
Resumen
Resumen
Antecedentes: La principal causa de deterioro en la función renal en pacientes diabéticos es la nefropatía diabética (ND), pero existen otras causas que siempre se deben investigar especialmente cuando en ellos no se detecta macroalbuminuria
Objetivo: Caracterización de variables demográficas, clínicas y etiológicas encontradas en una población de diabéticos tipo 2 de mas de 10 años de evolución no macroalbuminuricos con elevación de azoados.
Métodos: Se identificaron 67 pacientes, en los cuales se practicaron diversos estudios imagenologicos para lograr un diagnostico etiológico. Si los estudios no fueron concluyentes, se procedió a practicar biopsia renal percutánea
Resultados: La media de edad fue de 73,4 años (DE: 9,3). Media de creatinina 1,8 mg/dl, 50,75% de los pacientes presentaron albuminuria normal (A1) y 49,3% albuminuria moderadamente incrementada (A2). En 28 pacientes se obtuvo diagnósticos por imágenes, siendo la nefropatía hipertensiva el principal hallazgo. Se practico biopsia renal al 58,20% (39 pacientes) de la población, y en ellos los diagnósticos fueron ND aislada en el 28% de los casos (11 pacientes), nefroesclerosis hipertensiva 28% (11 pacientes), nefropatía mixta (diabética e hipertensiva) 18% (7 pacientes), nefropatía por IgA 5% (2 pacientes).
Conclusiones: La nefropatía hipertensiva es la principal causa de elevacion de azoados en diabeticos tipo 2 no macroalbuminuricos. La ND aislada solo explica el 16,42% (11 pacientes) de las causas de esta poblacion.
Citas
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2. Kramer HJ, Nguyen QD, Curhan G, Hsu CY. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. Jama. 2003;289(24):3273-7. Disponible en: https://doi.org/10.1001/jama.289.24.3273
3. Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR. UKPDS Study. Risk factors for renal dysfunction in type 2 diabetes: U.K. Prospective Diabetes Study 74. Diabetes. 2006;55(6):1832-9. Disponible en: https://doi.org/10.2337/db05-1620
4. Halimi JM. The emerging concept of chronic kidney disease without clinical proteinuria in diabetic patients. Diabetes Metab. 2012;38(4):291-7. Disponible en: https://doi.org/10.1016j.diabet.2012.04.001
5. Laranjinha I, Matias P, Mateus S, Aguiar F, Pereira P, Santos MP et al. Diabetic kidney disease: Is there a non-albuminuric phenotype in type 2 diabetic patients?. Nefrología. 2016;36(5): 503-9. Disponible en: https://doi.org/10.1016/j.nefro.2016.03.025
6. Mottl AK, Kwon KS, Mauer M, Mayer-Davis EJ, Hogan SL, Kshirsagar AV. Normoalbuminuric diabetes kidney disease in the U.S. population. J Diabetes Complications. 2013;27(2):123-7. Disponible en: https://doi.org10.1016/j.jdiacomp.2012.09.010
7. Boronat M, Garcia-Canton C, Quevedo V, Lorenzo DL, Lopez-Rios L, Batista F et al. Non-albuminuric renal disease among subject with advanced stages of chronic kidney failure related to type 2 diabetes mellitus. Ren Fail. 2014;36(2):166-70. Disponible en: https://doi.org/10.3109/0886022X.2013.835266
8. Gonzalez Suarez ML, Thomas DB, Barisoni L, Fornoni A. Diabetic nephropathy: Is it time yet for routine kidney biopsy?. World J Diabetes 2013;4(6): 245-255. Disponible en: https://doi.org/10.4239/wjd.v4.i6.245
9. Fiorini F, Barozzi L. The role of ultrasonography in the study of medical nephropathy. J Ultrasound. 2007;10(4):161-7. Disponible en: https://doi.org/10.1016/j.jus.2007.09.001
10. Meola M, Petrucci I. Color Doppler sonography in the study of chronic ischemic nephropathy. J Ultrasound. 2008;11(2): 55-73. Disponible en: https://doi.org/10.1016/j.jus.2008.03.006
11. Tervaert TW, Mooyaart AL, Amann K, Cohen AH, Cook HT, Drachenberg CB et al. Pathologic classification of diabetic nephropathy. J Am Soc Nephrol. 2010;21(4):556-63. Disponible en: https://doi.org 10.1681/ASN.2010010010
12. Helmchen U. Effects of hypertension on renal vasculature and structure. In: Cameron S, Davison AM, Grünfeld JP, editors. Oxford Textbook of Clinical Nephrology. Oxford: Oxford University Press; 1992. p. 2075.
13. Wang XC Liu CH, Chen YJ, Wu Y, Yang LS, Liu HM, Liao HL. Clinical and pathological analysis of the kidney in patients with hypertensive nephropathy. Exp Ther Med. 2013;6(5):1243-6. Disponible en: https://doi.org/10.3892/etm.2013.1306
14. Sharma SG, Bomback AS, Radhakrishnan J, Herlitz LC, Stokes MB, Markowitz GS, D’Agati VD. The modern spectrum of renal biopsy findings in patients with diabetes. Clin J Am Soc Nephrol. 2013;8(10):1718-24. Disponible en: https://doi.org/10.2215/CJN.02510213
15. KDIGO. 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Supplement. 2013; 3(1):5-14.
16. Mogensen CE, Christensen CK, Vittinghus E. The stages in diabetic renal disease. With emphasis on the stage of incipient diabetic nephropathy. Diabetes. 1983;32(Suppl 2):64-78. Disponible en: https://doi.org/10.2337/diab.32.2.S64
17. Caramori M, Fioretto P, Mauer M. Low glomerular filtration rate in normoalbuminuric type 1 diabetic patients: an indicator of more advanced glomerular lesions. Diabetes. 2003;52(4):1036-40. Disponible en: https://doi.org/10.2337/diabetes.52.4.1036
18. Ghani AA; Waheeb SA, Shahow AA, Hussain N. Renal biopsy in patients with type 2 diabetes mellitus: indications and nature of the lesions. Ann Saudi Med. 2009;29(6):450-3. Disponible en: https://doi.org 10.4103/0256-4947.57167
19. Nzerue CM, Hewan-Lowe K, Harvey P, Mohammed D, Furlong B, Oster R. Prevalence of non-diabetic renal disease among African-American patients with type II diabetes mellitus. Scand J Urol Nephrol. 2000;34(5):331-5. Disponible en: https://doi.org/10.1080003655900750048378
20. Lee EY, Chung CH, Choi SO. Non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus. Yonsei Med J. 1999;40(4):321-6. Disponible en: https://doi.org/10.3349ymj.1999.40.4.321
21. Izzedinea H, Fongoroa S, Pajota O, Beaufilsb H, Deraya G. Retinopathy, Hematuria, and Diabetic Nephropathy. Nephron. 2001;88(4):382-3. Disponible en: https://doi.org/10.1159/000046025
22. Castellano I, Covarsi A, Novillo R, Gomez-Martino JR, Ferrando L. Renal histological lesions in patients with type II diabetes mellitus. Nefrologia. 2002;22(2):162-9.
23. Phama TT, Sim JJ, Kujubu DA, Liu IL, Kumar VA. Prevalence of Nondiabetic Renal Disease in Diabetic Patients. Am J Nephrol. 2007;27(3):322-28. Disponible en: https://doi.org/10.1159/000102598
24. Mou S, Wang Q, Liu J, Che X, Zhang M, Cao L et al. Prevalence of non diabetic renal disease in patients with type 2 diabetes. Diabetes Res Clin Pract. 2010;87(3):354-9. Disponible en: https://doi.org/10.1016j.diabres.2009.11.012
25. Premalatha G, Vidhya K, Deepa R, Ravikumar R, Rema M, Mohan V. Prevalence of non-diabetic renal disease in type 2 diabetic patients in a diabetes centre in Southern India. J Assoc Physicians India. 2002;50:1135-9.
26. Moger V, Kumar SK, Sakhuja V, Joshi K, Walker R, Kohli HS, Sud K, Gupta KL, Jha V. Rapidly progressive renal failure in type 2 diabetes in the tropical environment: a clinico-pathological study. Ren Fail. 2005;27(5):595-600. Disponible en: https://doi.org/10.108008860220500200205
27. Soni SS, Gowrishankar S, Kishan AG, Raman A. Non diabetic renal disease in type 2 diabetes mellitus. Nephrology (Carlton). 2006;11(6):533-7. Disponible en: https://doi.org/10.1111j.1440-1797.2006.00681.x
28. Ekinci EI, Jerums G, Skene A, Crammer P, Power D, Cheong KY, et al. Renal structure in normoalbuminuric and albuminuric patients with type 2 diabetes and impaired renal function. Diabetes Care. 2013;36(11):3620-6. Disponible en: https://doi.org/10.2337/dc12-2572
29. Fioretto P, Mauer M, Brocco E, Velussi M, Frigato F, Muollo B, et al. Patterns of renal injury in NIDDM patients with microalbuminuria. Diabetologia. 1996;39(12):1569-76. Disponible en: https://doi.org10.1007/s001250050616
30. Shimizu M, Furuichi K, Yokoyama H, Toyama T, Iwata Y, Sakai N et al. Clin Exp Nephrol. 2014;18(2):305-12. Disponible en: https://doi.org10.1007/s10157-013-0870-0
31. Chong YB, Keng TC, Tan LP, Ng KP, Kong WY, Wong CM et al. Clinical predictors of non-diabetic renal disease and role of renal biopsy in diabetic patients with renal involvement: a single centre review. Ren Fail. 2012;34(3):323-8. Disponible en: https://doi.org/10.31090886022X.2011.647302
32. Yaqub S, Kashif W, Hussain SA. Non-diabetic renal disease in patients with type-2 diabetes mellitus. Saudi J Kidney Dis Transpl. 2012;23(5):1000-7. Disponible en: https://doi.org/10.41031319-2442.100882
33. Ritchie CM, Mcllrath E, Hadden DR, Weaver JA, Kennedy L, Atkinson AB. Renal artery stenosis in hypertensive diabetic patientes. Diabetic Med. 1988;5(3):265-7. Disponible en: https://doi.org/10.1111j.1464-5491.1988.tb00982.x
34. Horvatic I, Tisljar M, Kacinari P, Matesic I, Bulimbasic S, Ljubanovic et al. Non-diabetic renal disease in croatian patints with type 2 diabetes mellitus. Diabetic Res Clin Pract. 2014;104(3):443-50. Disponible en: https://doi.org/10.1016/j.diabres.2014.03.016
35. 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. Disponible en: https://doi.org/10.31090886022X.2010.536292
36. Liu S, Guo Q, Han H, Cui P, Liu X, Miao L, Zou H, Sun G. Clinicopathological characteristics of non-diabetic renal disease in patients with type 2 diabetes mellitus in a northeastern Chinese medical center: a retrospective analysis of 273 cases. Int Urol Nephrol. 2016;48(10):1691-8. Disponible en: https://doi.org10.1007s11255-016-1331-y
37. Li L, Zhang X, Li Z, Zhang R, Guo R, Yin Q, Yang L, Yue R, Su B, Huang S, Xu H, He C, Liu F. Renal pathological implications in type 2 diabetes mellitus patients with renal involvement. J Diabetes Complications. 2017;31(1):114-21. Disponible en: https://doi.org/10.1016j.jdiacomp.2016.10.024
2. Kramer HJ, Nguyen QD, Curhan G, Hsu CY. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. Jama. 2003;289(24):3273-7. Disponible en: https://doi.org/10.1001/jama.289.24.3273
3. Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR. UKPDS Study. Risk factors for renal dysfunction in type 2 diabetes: U.K. Prospective Diabetes Study 74. Diabetes. 2006;55(6):1832-9. Disponible en: https://doi.org/10.2337/db05-1620
4. Halimi JM. The emerging concept of chronic kidney disease without clinical proteinuria in diabetic patients. Diabetes Metab. 2012;38(4):291-7. Disponible en: https://doi.org/10.1016j.diabet.2012.04.001
5. Laranjinha I, Matias P, Mateus S, Aguiar F, Pereira P, Santos MP et al. Diabetic kidney disease: Is there a non-albuminuric phenotype in type 2 diabetic patients?. Nefrología. 2016;36(5): 503-9. Disponible en: https://doi.org/10.1016/j.nefro.2016.03.025
6. Mottl AK, Kwon KS, Mauer M, Mayer-Davis EJ, Hogan SL, Kshirsagar AV. Normoalbuminuric diabetes kidney disease in the U.S. population. J Diabetes Complications. 2013;27(2):123-7. Disponible en: https://doi.org10.1016/j.jdiacomp.2012.09.010
7. Boronat M, Garcia-Canton C, Quevedo V, Lorenzo DL, Lopez-Rios L, Batista F et al. Non-albuminuric renal disease among subject with advanced stages of chronic kidney failure related to type 2 diabetes mellitus. Ren Fail. 2014;36(2):166-70. Disponible en: https://doi.org/10.3109/0886022X.2013.835266
8. Gonzalez Suarez ML, Thomas DB, Barisoni L, Fornoni A. Diabetic nephropathy: Is it time yet for routine kidney biopsy?. World J Diabetes 2013;4(6): 245-255. Disponible en: https://doi.org/10.4239/wjd.v4.i6.245
9. Fiorini F, Barozzi L. The role of ultrasonography in the study of medical nephropathy. J Ultrasound. 2007;10(4):161-7. Disponible en: https://doi.org/10.1016/j.jus.2007.09.001
10. Meola M, Petrucci I. Color Doppler sonography in the study of chronic ischemic nephropathy. J Ultrasound. 2008;11(2): 55-73. Disponible en: https://doi.org/10.1016/j.jus.2008.03.006
11. Tervaert TW, Mooyaart AL, Amann K, Cohen AH, Cook HT, Drachenberg CB et al. Pathologic classification of diabetic nephropathy. J Am Soc Nephrol. 2010;21(4):556-63. Disponible en: https://doi.org 10.1681/ASN.2010010010
12. Helmchen U. Effects of hypertension on renal vasculature and structure. In: Cameron S, Davison AM, Grünfeld JP, editors. Oxford Textbook of Clinical Nephrology. Oxford: Oxford University Press; 1992. p. 2075.
13. Wang XC Liu CH, Chen YJ, Wu Y, Yang LS, Liu HM, Liao HL. Clinical and pathological analysis of the kidney in patients with hypertensive nephropathy. Exp Ther Med. 2013;6(5):1243-6. Disponible en: https://doi.org/10.3892/etm.2013.1306
14. Sharma SG, Bomback AS, Radhakrishnan J, Herlitz LC, Stokes MB, Markowitz GS, D’Agati VD. The modern spectrum of renal biopsy findings in patients with diabetes. Clin J Am Soc Nephrol. 2013;8(10):1718-24. Disponible en: https://doi.org/10.2215/CJN.02510213
15. KDIGO. 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Supplement. 2013; 3(1):5-14.
16. Mogensen CE, Christensen CK, Vittinghus E. The stages in diabetic renal disease. With emphasis on the stage of incipient diabetic nephropathy. Diabetes. 1983;32(Suppl 2):64-78. Disponible en: https://doi.org/10.2337/diab.32.2.S64
17. Caramori M, Fioretto P, Mauer M. Low glomerular filtration rate in normoalbuminuric type 1 diabetic patients: an indicator of more advanced glomerular lesions. Diabetes. 2003;52(4):1036-40. Disponible en: https://doi.org/10.2337/diabetes.52.4.1036
18. Ghani AA; Waheeb SA, Shahow AA, Hussain N. Renal biopsy in patients with type 2 diabetes mellitus: indications and nature of the lesions. Ann Saudi Med. 2009;29(6):450-3. Disponible en: https://doi.org 10.4103/0256-4947.57167
19. Nzerue CM, Hewan-Lowe K, Harvey P, Mohammed D, Furlong B, Oster R. Prevalence of non-diabetic renal disease among African-American patients with type II diabetes mellitus. Scand J Urol Nephrol. 2000;34(5):331-5. Disponible en: https://doi.org/10.1080003655900750048378
20. Lee EY, Chung CH, Choi SO. Non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus. Yonsei Med J. 1999;40(4):321-6. Disponible en: https://doi.org/10.3349ymj.1999.40.4.321
21. Izzedinea H, Fongoroa S, Pajota O, Beaufilsb H, Deraya G. Retinopathy, Hematuria, and Diabetic Nephropathy. Nephron. 2001;88(4):382-3. Disponible en: https://doi.org/10.1159/000046025
22. Castellano I, Covarsi A, Novillo R, Gomez-Martino JR, Ferrando L. Renal histological lesions in patients with type II diabetes mellitus. Nefrologia. 2002;22(2):162-9.
23. Phama TT, Sim JJ, Kujubu DA, Liu IL, Kumar VA. Prevalence of Nondiabetic Renal Disease in Diabetic Patients. Am J Nephrol. 2007;27(3):322-28. Disponible en: https://doi.org/10.1159/000102598
24. Mou S, Wang Q, Liu J, Che X, Zhang M, Cao L et al. Prevalence of non diabetic renal disease in patients with type 2 diabetes. Diabetes Res Clin Pract. 2010;87(3):354-9. Disponible en: https://doi.org/10.1016j.diabres.2009.11.012
25. Premalatha G, Vidhya K, Deepa R, Ravikumar R, Rema M, Mohan V. Prevalence of non-diabetic renal disease in type 2 diabetic patients in a diabetes centre in Southern India. J Assoc Physicians India. 2002;50:1135-9.
26. Moger V, Kumar SK, Sakhuja V, Joshi K, Walker R, Kohli HS, Sud K, Gupta KL, Jha V. Rapidly progressive renal failure in type 2 diabetes in the tropical environment: a clinico-pathological study. Ren Fail. 2005;27(5):595-600. Disponible en: https://doi.org/10.108008860220500200205
27. Soni SS, Gowrishankar S, Kishan AG, Raman A. Non diabetic renal disease in type 2 diabetes mellitus. Nephrology (Carlton). 2006;11(6):533-7. Disponible en: https://doi.org/10.1111j.1440-1797.2006.00681.x
28. Ekinci EI, Jerums G, Skene A, Crammer P, Power D, Cheong KY, et al. Renal structure in normoalbuminuric and albuminuric patients with type 2 diabetes and impaired renal function. Diabetes Care. 2013;36(11):3620-6. Disponible en: https://doi.org/10.2337/dc12-2572
29. Fioretto P, Mauer M, Brocco E, Velussi M, Frigato F, Muollo B, et al. Patterns of renal injury in NIDDM patients with microalbuminuria. Diabetologia. 1996;39(12):1569-76. Disponible en: https://doi.org10.1007/s001250050616
30. Shimizu M, Furuichi K, Yokoyama H, Toyama T, Iwata Y, Sakai N et al. Clin Exp Nephrol. 2014;18(2):305-12. Disponible en: https://doi.org10.1007/s10157-013-0870-0
31. Chong YB, Keng TC, Tan LP, Ng KP, Kong WY, Wong CM et al. Clinical predictors of non-diabetic renal disease and role of renal biopsy in diabetic patients with renal involvement: a single centre review. Ren Fail. 2012;34(3):323-8. Disponible en: https://doi.org/10.31090886022X.2011.647302
32. Yaqub S, Kashif W, Hussain SA. Non-diabetic renal disease in patients with type-2 diabetes mellitus. Saudi J Kidney Dis Transpl. 2012;23(5):1000-7. Disponible en: https://doi.org/10.41031319-2442.100882
33. Ritchie CM, Mcllrath E, Hadden DR, Weaver JA, Kennedy L, Atkinson AB. Renal artery stenosis in hypertensive diabetic patientes. Diabetic Med. 1988;5(3):265-7. Disponible en: https://doi.org/10.1111j.1464-5491.1988.tb00982.x
34. Horvatic I, Tisljar M, Kacinari P, Matesic I, Bulimbasic S, Ljubanovic et al. Non-diabetic renal disease in croatian patints with type 2 diabetes mellitus. Diabetic Res Clin Pract. 2014;104(3):443-50. Disponible en: https://doi.org/10.1016/j.diabres.2014.03.016
35. 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. Disponible en: https://doi.org/10.31090886022X.2010.536292
36. Liu S, Guo Q, Han H, Cui P, Liu X, Miao L, Zou H, Sun G. Clinicopathological characteristics of non-diabetic renal disease in patients with type 2 diabetes mellitus in a northeastern Chinese medical center: a retrospective analysis of 273 cases. Int Urol Nephrol. 2016;48(10):1691-8. Disponible en: https://doi.org10.1007s11255-016-1331-y
37. Li L, Zhang X, Li Z, Zhang R, Guo R, Yin Q, Yang L, Yue R, Su B, Huang S, Xu H, He C, Liu F. Renal pathological implications in type 2 diabetes mellitus patients with renal involvement. J Diabetes Complications. 2017;31(1):114-21. Disponible en: https://doi.org/10.1016j.jdiacomp.2016.10.024
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