Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
Institute of Nephrology, Peking University, Beijing, China.
Front Endocrinol (Lausanne). 2021 Oct 26;12:761386. doi: 10.3389/fendo.2021.761386. eCollection 2021.
As the most common complication of diabetes mellitus (DM), diabetic nephropathy (DN) was initially considered to begin with proteinuria preceding the progression of renal insufficiency. This clinical paradigm has been questioned in the late decades, as many DM patients without proteinuria have progressive renal insufficiency. However, the characteristics of nonproteinuric DN were not fully clear yet.
A total of 390 patients with renal biopsy-proven DN in our center were retrospectively recruited in the current study. Clinical and histopathological data of the patients were analyzed. We used propensity score-matching methods to address the imbalance of age, sex, and diabetes duration for comparative analyses.
Among all the renal biopsy-proven DN patients with renal biopsy proven DN, 18 patients were classified as nonproteinuric DN. Compared with 36 propensity score-matched proteinuric DN patients, diabetic retinopathy (DR) was less frequent in nonproteinuric DN patients (38.9% 66.4%, p<0.05). During the follow-up of 24.0 (12.0-42.0) months, the probability of developing the end-stage renal disease (ESRD) was significantly lower in nonproteinuric DN patients than in proteinuric ones in both the propensity score-matched cohort and overall cohort (log-rank test, p<0.001 and p<0.001, respectively).
Compared with proteinuric DN patients, DR was less frequent in nonproteinuric DN patients. Nonproteinuric DN patients had better renal outcomes than proteinuric DN patients.
糖尿病肾病（DN）是糖尿病（DM）最常见的并发症，最初被认为是从蛋白尿开始，然后进展为肾功能不全。在过去的几十年中，这种临床模式受到了质疑，因为许多没有蛋白尿的 DM 患者也会出现进行性肾功能不全。然而，非蛋白尿性 DN 的特征尚不完全清楚。
本研究回顾性招募了 390 例在我院接受肾活检证实的 DN 患者。分析了患者的临床和组织病理学数据。我们使用倾向评分匹配方法来解决年龄、性别和糖尿病病程的不平衡问题，以便进行比较分析。
在所有经肾活检证实的 DN 患者中，有 18 例被归类为非蛋白尿性 DN。与 36 例匹配的蛋白尿性 DN 患者相比，非蛋白尿性 DN 患者的糖尿病视网膜病变（DR）发生率较低（38.9% 比 66.4%，p<0.05）。在 24.0（12.0-42.0）个月的随访期间，非蛋白尿性 DN 患者发生终末期肾病（ESRD）的概率明显低于蛋白尿性 DN 患者，无论是在倾向评分匹配队列还是在总体队列中（对数秩检验，p<0.001 和 p<0.001）。
与蛋白尿性 DN 患者相比，DR 在非蛋白尿性 DN 患者中较少见。非蛋白尿性 DN 患者的肾脏预后优于蛋白尿性 DN 患者。
