Yaqub Sonia, Kashif Waqar, Hussain Syed Ather
Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Saudi J Kidney Dis Transpl. 2012 Sep;23(5):1000-7. doi: 10.4103/1319-2442.100882.
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease in diabetics worldwide, yet most patients with type-2 diabetes mellitus are not formally evaluated with a renal biopsy. The diagnosis is almost always based on clinical grounds. A wide spectrum of non-diabetic renal disease (NDRD) is reported to occur in patients with type-2 diabetes. It has been estimated that up to one-third of all diabetic patients who present with proteinuria are suffering from NDRD. The aim of this analysis was to evaluate the prevalence and etiology of NDRD in patients with type-2 diabetes. We retrospectively reviewed the medical records of patients with type-2 diabetes who underwent kidney biopsy on clinical suspicion of NDRD (absence of diabetic retinopathy and/or neuropathy; short duration of diabetes, i.e. less than five years) from January 2003 through December 2007 at the Aga Khan University Hospital, Karachi. Based on the biopsy findings, patients were grouped as Group-I, isolated NDRD; Group-II, NDRD with underlying DN; and Group-III, isolated DN. Of 68 patients studied, 75% were males and the mean age was 56 years. The mean duration of diabetes was nine years. Group-I included 34 patients (52%), Group-II included 11 patients (17%) and Group-III included 23 patients (31%). Among the Group-I patients, the mean age was 56 years (41-77 years). The most common NDRDs were acute interstitial nephritis (32%), diffuse proliferative glomerulonephritis (17%); membranous nephropathy (12%) and crescentic glomerulonephritis (12%). Among Group-II, the mean age was 60 years (46-71 years), and the most common lesion was interstitial nephritis superimposed on underlying DN (63% cases). Among Group-III, the mean age was 53 years (42- 80 years). The mean proteinuria was 5, 6.3 and 7.3 g/24 h of urine collection in Groups I, II and III, respectively (P = NS). The mean duration of diabetes was 7.3, 11.7 and 10.7 years in Groups I, II and III, respectively. The duration of diabetes was significantly less in Group-I compared with Group-II and Group-III (P = 0.04). Our study suggests that the prevalence of NDRD (either isolated or superimposed on underlying DN) is high in appropriate clinical settings. Performing renal biopsy in diabetics with no extrarenal end organ damage other than nephropathy helps to diagnose and treat NDRD. This is the first report from Pakistan documenting the prevalence of NDRD in patients with type-2 diabetes.
糖尿病肾病（DN）是全球糖尿病患者终末期肾病的主要病因，但大多数2型糖尿病患者并未接受正式的肾活检评估。诊断几乎总是基于临床依据。据报道，2型糖尿病患者中存在多种非糖尿病性肾病（NDRD）。据估计，所有出现蛋白尿的糖尿病患者中，高达三分之一患有NDRD。本分析的目的是评估2型糖尿病患者中NDRD的患病率和病因。我们回顾性分析了2003年1月至2007年12月在卡拉奇阿迦汗大学医院因临床怀疑患有NDRD（无糖尿病视网膜病变和/或神经病变；糖尿病病程短，即少于5年）而接受肾活检的2型糖尿病患者的病历。根据活检结果，患者分为三组：第一组，孤立性NDRD；第二组，合并潜在DN的NDRD；第三组，孤立性DN。在研究的68例患者中，75%为男性，平均年龄为56岁。糖尿病平均病程为9年。第一组包括34例患者（52%），第二组包括11例患者（17%），第三组包括23例患者（31%）。在第一组患者中，平均年龄为56岁（41 - 77岁）。最常见的NDRD是急性间质性肾炎（32%）、弥漫性增生性肾小球肾炎（17%）、膜性肾病（12%）和新月体性肾小球肾炎（12%）。在第二组中，平均年龄为60岁（46 - 71岁），最常见的病变是叠加在潜在DN基础上的间质性肾炎（63%的病例）。在第三组中，平均年龄为53岁（42 - 80岁）。第一组、第二组和第三组24小时尿蛋白定量分别为5、6.3和7.3 g（P = 无显著性差异）。第一组、第二组和第三组的糖尿病平均病程分别为7.3、11.7和10.7年。与第二组和第三组相比，第一组的糖尿病病程显著更短（P = 0.04）。我们的研究表明，在适当的临床环境中，NDRD（无论是孤立性还是叠加在潜在DN基础上）的患病率很高。对除肾病外无肾外终末器官损害的糖尿病患者进行肾活检有助于诊断和治疗NDRD。这是巴基斯坦第一份记录2型糖尿病患者中NDRD患病率的报告。
