Arora Puneet, Roychaudhury Arpita, Pandey Rajendra
Department of Nephrology, Max Super Speciality Hospital, Dehradun, Uttarakhand, India.
Department of Nephrology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
Indian J Nephrol. 2020 Sep-Oct;30(5):295-300. doi: 10.4103/ijn.IJN_13_19. Epub 2020 Aug 27.
Non-diabetic renal diseases (NDRDs) form an important part of disease manifestations in patients with diabetes.
This hospital-based prospective study was conducted to analyze incidence and spectrum of NDRDs in patients with diabetes with or without diabetic nephropathy (DN), effect of early specific interventions on outcome, and renal-retinal relationship in type 1 and type 2 diabetes mellitus with nephropathy. 44 Patients with T2DM with the clinical suspicion of NDRD were subjected to renal biopsy Renal biopsies were performed by using an automated biopsy gun. Tissue was processed for Light microscopy-LM and Immunofluorescence-IF. Electron Microscopy was done as and when required by reprocessing the tissue embedded in paraffin for LM. Biopsies were reported by one experienced renal pathologist.
Renal histopathology revealed that of 44 enrolled patients with clinically suspected NDRD, 61.4% had isolated NDRD, 13.6% had NDRD superimposed on DN, and 25% had isolated DN. The most common NDRDs were minimal change disease (19.2%) and DN + chronic pyelonephritis (33.3%) in patients with isolated NDRD, and NDRD superimposed on DN, respectively. In the DN group, no patient had proliferative diabetic retinopathy (PDR) or hypertensive retinopathy, 45.5% had nonproliferative diabetic retinopathy (NPDR) and 54.5% had no microangiopathy in retina. In the NDRD group, 9.1% each had PDR and hypertensive retinopathy, 36.4% had NPDR and 45.4% had no microangiopathy in retina. No patient in the DN group and 72.7% in the NDRD group received specific treatment. In hospital, dialysis support was provided to 27.3% and 21.2% of patients in the DN and NDRD groups, respectively. In the DN group, 72.7% of patients improved with conservative therapy, 18.2% were dependent on dialysis when discharged. One patient died during treatment. In the NDRD group, 78.8% showed recovery in the renal function and clinical improvement, 15.1% were dialysis dependent when discharged. Two patients died during treatment.
Accurate diagnosis of underlying NDRD by kidney biopsy facilitates initiation of specific therapy, which may lead to clinical improvement in significant number of patients.
非糖尿病性肾脏疾病（NDRDs）是糖尿病患者疾病表现的重要组成部分。
本项基于医院的前瞻性研究旨在分析合并或不合并糖尿病肾病（DN）的糖尿病患者中NDRDs的发病率及谱型、早期特异性干预对预后的影响以及1型和2型糖尿病肾病患者的肾视网膜关系。44例临床怀疑患有NDRD的2型糖尿病患者接受了肾活检。肾活检采用自动活检枪进行。组织进行光镜（LM）和免疫荧光（IF）处理。根据需要，通过重新处理石蜡包埋的组织进行电子显微镜检查。活检报告由一位经验丰富的肾脏病理学家完成。
肾脏组织病理学显示，在44例临床怀疑患有NDRD的入组患者中，61.4%患有孤立性NDRD，13.6%患有NDRD合并DN，25%患有孤立性DN。在孤立性NDRD患者以及合并DN的NDRD患者中，最常见的NDRDs分别是微小病变病（19.2%）和DN + 慢性肾盂肾炎（33.3%）。在DN组中，没有患者患有增殖性糖尿病视网膜病变（PDR）或高血压性视网膜病变，45.5%患有非增殖性糖尿病视网膜病变（NPDR），54.5%视网膜无微血管病变。在NDRD组中，9.1%的患者患有PDR和高血压性视网膜病变，36.4%患有NPDR，45.4%视网膜无微血管病变。DN组中没有患者接受特异性治疗，NDRD组中有72.7%的患者接受了特异性治疗。在医院，DN组和NDRD组分别有27.3%和21.2%的患者接受了透析支持。在DN组中，72.7%的患者经保守治疗病情改善，18.2%出院时依赖透析。1例患者在治疗期间死亡。在NDRD组中，78.8%的患者肾功能恢复且临床症状改善，15.1%出院时依赖透析。2例患者在治疗期间死亡。
通过肾活检准确诊断潜在的NDRD有助于启动特异性治疗，这可能使大量患者临床症状改善
