2 型糖尿病患者临床肾脏疾病的组织学谱，特别关注非白蛋白尿性糖尿病肾病：一项基于肾脏活检的研究。

Histological Spectrum of Clinical Kidney Disease in Type 2 Diabetes Mellitus Patients with special Reference to nonalbuminuric Diabetic Nephropathy: A Kidney Biopsy-based Study.

机构信息

Retired Professor.

Senior Resident; Corresponding Author.

出版信息

J Assoc Physicians India. 2022 Aug;70(8):11-12. doi: 10.5005/japi-11001-0060.

DOI:10.5005/japi-11001-0060

PMID:36082725

Abstract

BACKGROUND

Diabetic nephropathy (DN) is an important and catastrophic complication of diabetes mellitus (DM). Kidney disease has heterogeneity in histology in diabetes patients and includes both diabetic kidney disease (DKD) (albuminuric or nonalbuminuric) and nondiabetic kidney disease (NDKD) either in isolation or in coexistence with DN. Diabetic nephropathy is hard to overturn. While NDKD is treatable and reversible.

MATERIALS AND METHODS

We enrolled a total of 50 type 2 diabetes mellitus (T2DM) patients with clinical kidney disease, of both genders and age >18 years, who underwent kidney biopsy from October 2016 to October 2018. Patients with proteinuria <30 mg per day were excluded from the study. The indications of the renal biopsy were nephrotic syndrome (NS), active urinary sediment, rapid decline in renal function, asymptomatic proteinuria, and hematuria.

RESULT

A total of 50 (males: 42 and females: eight) patients with T2DM who underwent kidney biopsy were enrolled. The clinical presentation was: NS 26 (52%), chronic kidney disease (CKD) 11 (22%), asymptomatic proteinuria and hematuria six (12%), acute kidney injury (AKI) four (8%), and acute nephritic syndrome (ANS) three (6%). Diabetic retinopathy (DR) was noted in 19 (38%) cases. Kidney biopsy revealed isolated DN, isolated NDKD, and NDKD superimposed on DN in 26 (52%), 14 (28%), and 10 (20%) cases, respectively. Idiopathic membranous nephropathy (MN) (4) and amyloidosis (2) were the most common forms of NDKD, whereas diffuse proliferative glomerulonephritis (DPGN) was the main form of NDKD superimposed on DN. Diabetic nephropathy was observed in 15 (79%) cases in presence of DR and also in 11 (35.5%) cases even in absence of DR. Of eight patients with microalbuminuria four (50%) cases have biopsy-proven DN.

CONCLUSION

About 48% of patients had NDKD either in isolation or in coexistence with DN. Diabetic nephropathy was found in absence of DR and in patients with a low level of proteinuria. The level of proteinuria and presence of DR does not help to distinguish DN vs NDKD. Hence, renal biopsy may be useful in selected T2DM patients with clinical kidney disease to diagnose NDKD.

摘要

背景

糖尿病肾病（DN）是糖尿病（DM）的一种重要且灾难性的并发症。糖尿病患者的肾脏疾病在组织学上具有异质性，包括糖尿病性肾脏疾病（DKD）（白蛋白尿或非白蛋白尿）和非糖尿病性肾脏疾病（NDKD），无论是单独存在还是与 DN 共存。糖尿病肾病难以逆转。而 NDKD 是可治疗和可逆转的。

材料和方法

我们共纳入了 50 名 2 型糖尿病（T2DM）患者，均为男女，年龄均大于 18 岁，他们于 2016 年 10 月至 2018 年 10 月期间接受了肾活检。我们排除了蛋白尿每天少于 30 毫克的患者。肾活检的适应证为肾病综合征（NS）、活动尿沉渣、肾功能快速下降、无症状性蛋白尿和血尿。

结果

共纳入了 50 名（男性：42 名，女性：8 名）接受肾活检的 T2DM 患者。临床表现为：NS26 例（52%），慢性肾脏病（CKD）11 例（22%），无症状性蛋白尿和血尿 6 例（12%），急性肾损伤（AKI）4 例（8%），急性肾炎综合征（ANS）3 例（6%）。19 例（38%）患者发现有糖尿病视网膜病变（DR）。肾活检显示孤立性 DN、孤立性 NDKD 和 NDKD 合并 DN 分别为 26 例（52%）、14 例（28%）和 10 例（20%）。特发性膜性肾病（MN）（4 例）和淀粉样变性（2 例）是 NDKD 最常见的形式，而弥漫性增生性肾小球肾炎（DPGN）是 NDKD 合并 DN 的主要形式。DR 存在时，15 例（79%）患者观察到糖尿病肾病，11 例（35.5%）患者即使在无 DR 的情况下也观察到糖尿病肾病。8 例微量白蛋白尿患者中，有 4 例（50%）有活检证实的 DN。