Department of Nephrology, The Affiliated Hospital of Guizhou Medical University, Guiyi Street, Yunyan District, Guiyang, 550004, China.
Department of Endocrinology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China.
BMC Endocr Disord. 2022 Jun 30;22(1):168. doi: 10.1186/s12902-022-01082-8.
Nondiabetic kidney disease (NDKD), which is prevalent among patients with diabetes mellitus (DM), is considerably different from diabetic kidney disease (DKD) in terms of the pathological features, treatment strategy and prognosis. Although renal biopsy is the current gold-standard diagnostic method, it cannot be routinely performed due to a range of risks. The aim of this study was to explore the predictors for differentiating NDKD from DKD to meet the urgent medical needs of patients who cannot afford kidney biopsy.
This is a retrospective study conducted by reviewing the medical records of patients with type 2 DM who underwent percutaneous renal biopsy at the Affiliated Hospital of Guizhou Medical University between January 2017 and May 2021. The demographic data, clinical data, blood test results, and pathological examination results of the patients were obtained from their medical records. Multivariate regression analysis was performed to evaluate the predictive factors for NDKD.
A total of 244 patients were analyzed. The median age at biopsy was 55 (46, 62) years. Patients diagnosed with true DKD, those diagnosed with NDKD and those diagnosed with NDKD superimposed DKD represented 48.36% (118/244), 45.9% (112/244) and 5.74% (14/244), respectively, of the patient population. Immunoglobulin A nephropathy was the most common type of lesion in those with NDKD (59, 52.68%) and NDKD superimposed DKD (10, 71.43%). Independent predictive indicators for diagnosing NDKD included a DM duration of less than 5 years (odds ratio [OR] = 4.476; 95% confidence interval [CI]: 2.257-8.877; P < 0.001), an absence of diabetic retinopathy (OR = 4.174; 95% CI: 2.049-8.502; P < 0.001), a high RBC count (OR = 1.901; 95% CI: 1.251-2.889; P = 0.003), and a negative of urinary glucose excretion test result (OR = 2.985; 95% CI: 1.474-6.044; P = 0.002)..
A DM duration less than 5 years, an absence of retinopathy, a high RBC count and an absence of urinary glucose excretion were independent indicators for the diagnosis of NDKD, suggesting that patients with NDKD may require a different treatment regimen than those with DKD.
非糖尿病性肾脏疾病（NDKD）在糖尿病患者中较为常见，其病理特征、治疗策略和预后与糖尿病肾病（DKD）有很大不同。虽然肾活检是目前的金标准诊断方法，但由于存在多种风险，无法常规进行。本研究旨在探讨鉴别 NDKD 与 DKD 的预测因素，以满足不能进行肾活检的患者的迫切医疗需求。
这是一项回顾性研究，通过回顾 2017 年 1 月至 2021 年 5 月在贵州医科大学附属医院接受经皮肾活检的 2 型糖尿病患者的病历进行。从病历中获取患者的人口统计学数据、临床数据、血液检查结果和病理检查结果。采用多变量回归分析评估 NDKD 的预测因素。
共分析了 244 例患者。活检时的中位年龄为 55（46，62）岁。诊断为真 DKD、诊断为 NDKD 和诊断为 NDKD 合并 DKD 的患者分别占患者人群的 48.36%（118/244）、45.9%（112/244）和 5.74%（14/244）。诊断为 NDKD 的患者最常见的病变类型为 IgA 肾病（59 例，52.68%）和 NDKD 合并 DKD（10 例，71.43%）。诊断 NDKD 的独立预测指标包括糖尿病病程<5 年（优势比[OR] = 4.476；95%置信区间[CI]：2.257-8.877；P < 0.001）、无糖尿病视网膜病变（OR = 4.174；95% CI：2.049-8.502；P < 0.001）、高红细胞计数（OR = 1.901；95% CI：1.251-2.889；P = 0.003）和尿糖排泄试验结果阴性（OR = 2.985；95% CI：1.474-6.044；P = 0.002）。
糖尿病病程<5 年、无视网膜病变、高红细胞计数和尿糖排泄阴性是诊断 NDKD 的独立指标，提示 NDKD 患者可能需要与 DKD 患者不同的治疗方案。
