Kanodia Kamal V, Vanikar Aruna V, Nigam Lovelesh, Patel Rashmi D, Suthar Kamlesh S, Patel Himanshu
Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Center and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, India.
Department of Nephrology and Transplantation Medicine, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Center and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, India.
Saudi J Kidney Dis Transpl. 2017 Nov-Dec;28(6):1330-1337. doi: 10.4103/1319-2442.220877.
Diabetic nephropathy (DN) is a major complication of diabetes mellitus (DM), leading to chronic kidney disease/end-stage renal disease. Wide spectrum of nondiabetic renal diseases (NDRD) is reported in type-2 diabetes (type-2 DM). We carried out this single-center study to find clinical, laboratory, and histological features of NDRD in type-2 DM patients and to assess the prevalence of NDRD in India. A single-center retrospective study which included analysis of renal biopsies from patients with type-2 DM, performed between January 2008 and September 2016. Biopsy findings were categorized into three groups, Group-I (isolated NDRD); Group-II (NDRD superimposed on underlying DN); and Group-III (isolated DN). Out of 152 diabetic patients (111 males and 41 females), 35 (23.03%) patients were of Group-I (isolated NDRD), 35 (23.03%) of Group-II (NDRD superimposed on underlying DN), and 82 (53.95%) of Group-III (isolated DN). The mean age (in years) was 55.08 ± 10.71, 55.65 ± 8.71, and 54.45 ± 9.01 respectively in Group-I, II, and III. Nephrotic syndrome (NS) was the most common clinical presentation in all groups. Duration of DM was significantly shorter in Group-I than in Group-II. Diabetic retinopathy was absent in Group-I. Proteinuria was more in Group-III than Group-I. Low serum C3 and/or C4 levels was observed in five (14.29%) cases of Group-I and Group-II each and two (2.43%) cases of Group-III. Nearly, 70 (46.05%) patients were found to have NDRD either in isolated form or as combined lesions. The most common histological types of NDRD were acute tubulointerstitial nephritis (38.57%) followed by benign nephrosclerosis (15.72%), membranous nephropathy (10%), IgA nephropathy (7.14%), and membranoproliferative glomerulonephritis (7.14%). The incidence of NDRD (with/without DN) in type-2 DM is very high. Shorter duration of diabetes, hematuria, absence of retinopathy, low serum complement levels, and nephrotic range proteinuria are predictors of NDRD.
糖尿病肾病（DN）是糖尿病（DM）的主要并发症，可导致慢性肾脏病/终末期肾病。2型糖尿病（2型DM）患者中报道了多种非糖尿病性肾脏疾病（NDRD）。我们开展了这项单中心研究，以发现2型DM患者NDRD的临床、实验室和组织学特征，并评估印度NDRD的患病率。这是一项单中心回顾性研究，包括对2008年1月至2016年9月期间2型DM患者的肾活检进行分析。活检结果分为三组，第一组（孤立性NDRD）；第二组（NDRD叠加在潜在的DN上）；第三组（孤立性DN）。在152例糖尿病患者（111例男性和41例女性）中，35例（23.03%）属于第一组（孤立性NDRD），35例（23.03%）属于第二组（NDRD叠加在潜在的DN上），82例（53.95%）属于第三组（孤立性DN）。第一组、第二组和第三组的平均年龄（岁）分别为55.08±10.71、55.65±8.71和54.45±9.01。肾病综合征（NS）是所有组中最常见的临床表现。第一组的DM病程明显短于第二组。第一组无糖尿病视网膜病变。第三组的蛋白尿多于第一组。第一组和第二组各有5例（14.29%）、第三组有2例（2.43%）观察到低血清C3和/或C4水平。近70例（46.05%）患者被发现患有孤立形式或合并病变的NDRD。NDRD最常见的组织学类型是急性肾小管间质性肾炎（38.57%），其次是良性肾硬化（15.72%）、膜性肾病（10%）、IgA肾病（7.14%）和膜增生性肾小球肾炎（7.14%）。2型DM中NDRD（伴/不伴DN）的发生率非常高。糖尿病病程较短、血尿、无视网膜病变、低血清补体水平和肾病范围蛋白尿是NDRD的预测指标。
