Prakash J, Sen D, Kumar N S
Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi.
J Assoc Physicians India. 2001 Apr;49:415-20.
A wide spectrum of non-diabetic renal diseases (NDRD) are reported to occur in patients with type 2 diabetes mellitus. However, the prevalence and nature of NDRD in type 2 diabetics is not widely documented in our country. Therefore, the objectives of this study were to analyse prevalence and spectrum of non-diabetic renal disease in type 2 diabetic patients.
Two hundred sixty type 2 diabetic with clinical renal diseases were screened for evidence of NDRD, between April 1997 to March 1999. Renal disease other than diabetic nephropathy was found in 32 (12.3%) patients. Their (male 23; female 9) age ranged between 35-72 (mean 54.15+/-10.3) years. The duration of diabetes was < 5 years in 14 (43.7%), between 5-9 years in 8 (25%) and > 10 years in 10 (31.2%) patients.
The presenting clinical syndromes were : chronic renal failure 15 (47%), acute nephritic syndrome 6 (18.7%), nephrotic syndrome 5 (15.6%), acute renal failure 4 (12.5%) and rapidly progressive glomerulonephritis (RPGN) in 2 (6.2%) cases. Overall, incidence of glomerular (46.8%) and tubulo-interstitial lesions (53.2%) were almost equal in type 2 diabetes patients. The spectrum of non-diabetic renal diseases includes : primary isolated glomerulopathy 12 (37.5%); mesangioproliferative GN superimposed on diabetic glomerulosclerosis (DGS) in 3 (9.3%); acute tubulo-interstitial nephropathy (TIN) 4 (12.5%); chronic TIN 10 (31.25%) and three patients had chronic pyelonephritis. Diabetic retinopathy was absent in 22 (69%) cases where 10 (31%) patients had background diabetic retinopathy. None of the patients with non-diabetic glomerular disease had diabetic retinopathy, except two who had DGS in addition to mesangioproliferative GN on renal biopsy. The background diabetic retinopathy was seen in 47% of patients with TIN without clinical evidence of diabetic nephropathy. The recovery of renal function or clinical improvement was observed in 47% of patients with NDRD with institution of appropriate treatment.
The prevalence of NDRD was 12.3% in our type 2 diabetic patients. Both non-diabetic glomerulopathy (47%) and tubulo-interstitial nephropathy (53%) can occur with nearly equal frequency in such patients. It is also gratifying to diagnose and treat NDRD in type 2 diabetics in selected cases.
据报道，2型糖尿病患者中会出现多种非糖尿病性肾脏疾病（NDRD）。然而，我国2型糖尿病患者中NDRD的患病率和性质尚无广泛记录。因此，本研究的目的是分析2型糖尿病患者中非糖尿病性肾脏疾病的患病率和种类。
1997年4月至1999年3月期间，对260例患有临床肾脏疾病的2型糖尿病患者进行筛查，以寻找NDRD的证据。32例（12.3%）患者被发现患有糖尿病肾病以外的肾脏疾病。他们（男性23例；女性9例）的年龄在35 - 72岁之间（平均54.15±10.3岁）。糖尿病病程<5年的有14例（43.7%），5 - 9年的有8例（25%），>10年的有10例（31.2%）。
呈现的临床综合征为：慢性肾衰竭15例（47%），急性肾炎综合征6例（18.7%），肾病综合征5例（15.6%），急性肾衰竭4例（12.5%），快速进展性肾小球肾炎（RPGN）2例（6.2%）。总体而言，2型糖尿病患者中肾小球病变（46.8%）和肾小管间质病变（53.2%）的发生率几乎相等。非糖尿病性肾脏疾病的种类包括：原发性孤立性肾小球病12例（37.5%）；叠加在糖尿病肾小球硬化症（DGS）上的系膜增生性肾小球肾炎（GN）3例（9.3%）；急性肾小管间质性肾病（TIN）4例（12.5%）；慢性TIN 10例（31.25%），3例患者患有慢性肾盂肾炎。22例（69%）患者无糖尿病视网膜病变，10例（31%）患者有背景性糖尿病视网膜病变。除2例肾活检除系膜增生性GN外还伴有DGS的患者外，非糖尿病性肾小球疾病患者均无糖尿病视网膜病变。在无糖尿病肾病临床证据的TIN患者中，47%可见背景性糖尿病视网膜病变。给予适当治疗后，47%的NDRD患者肾功能恢复或临床症状改善。
在我们的2型糖尿病患者中，NDRD的患病率为12.3%。此类患者中非糖尿病性肾小球病（47%）和肾小管间质性肾病（53%）的发生频率几乎相等。在部分病例中对2型糖尿病患者的NDRD进行诊断和治疗也令人满意。
