Kim Wook-Joon, Oh Taehoon, Heo Nam Hun, Kwon Kyungsup, Shin Ga-Eun, Jeong Se-Hwi, Lee Ji Hye, Park Samel, Cho Nam-Jun, Gil Hyo-Wook, Lee Eun Young
Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
Department of Biostatistics, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
Kidney Res Clin Pract. 2025 Jan;44(1):91-101. doi: 10.23876/j.krcp.23.059. Epub 2024 Jan 12.
In patients with type 2 diabetes mellitus (T2DM), diabetic kidney disease (DKD) is diagnosed based on clinical features. A kidney biopsy is used only in selected cases. This study aimed to reconsider the role of a biopsy in predicting renal outcomes.
Clinical and laboratory parameters and renal biopsy results were obtained from 237 patients with T2DM who underwent renal biopsies at Soonchunhyang University Cheonan Hospital between January 2000 and March 2020 and were analyzed.
Of 237 diabetic patients, 29.1% had DKD only, 61.6% had non-DKD (NDKD), and 9.3% had DKD with coexisting NDKD (DKD/NDKD). Of the patients with DKD alone, 43.5% progressed to end-stage kidney disease (ESKD), while 15.8% of NDKD patients and 36.4% of DKD/NDKD patients progressed to ESKD (p < 0.001). In the DKD-alone group, pathologic features like ≥50% global sclerosis (p < 0.001), tubular atrophy (p < 0.001), interstitial fibrosis (p < 0.001), interstitial inflammation (p < 0.001), and the presence of hyalinosis (p = 0.03) were related to worse renal outcomes. The Cox regression model showed a higher risk of progression to ESKD in the DKD/NDKD group compared to the DKD-alone group (hazard ratio [HR], 2.73; p = 0.032), ≥50% global sclerosis (HR, 3.88; p < 0.001), and the degree of mesangial expansion (moderate: HR, 2.45; p = 0.045 and severe: HR, 6.22; p < 0.001).
In patients with T2DM, a kidney biopsy can help in identifying patients with NDKD for appropriate treatment, and it has predictive value.
在2型糖尿病（T2DM）患者中，糖尿病肾病（DKD）是根据临床特征诊断的。肾活检仅用于特定病例。本研究旨在重新审视活检在预测肾脏预后方面的作用。
收集了2000年1月至2020年3月期间在顺天乡大学天安医院接受肾活检的237例T2DM患者的临床和实验室参数以及肾活检结果，并进行分析。
在237例糖尿病患者中，29.1%仅患有DKD，61.6%患有非DKD（NDKD），9.3%患有合并NDKD的DKD（DKD/NDKD）。仅患有DKD的患者中，43.5%进展为终末期肾病（ESKD），而NDKD患者中有15.8%，DKD/NDKD患者中有36.4%进展为ESKD（p<0.001）。在仅患有DKD的组中，≥50%的全球硬化（p<0.001）、肾小管萎缩（p<0.001）、间质纤维化（p<0.001）、间质炎症（p<0.001）以及透明变性的存在（p=0.03）等病理特征与更差的肾脏预后相关。Cox回归模型显示，与仅患有DKD的组相比，DKD/NDKD组进展为ESKD的风险更高（风险比[HR]，2.73；p=0.032），≥50%的全球硬化（HR，3.88；p<0.001），以及系膜扩张程度（中度：HR，2.45；p=0.045；重度：HR，6.22；p<0.001）。
在T2DM患者中，肾活检有助于识别NDKD患者以进行适当治疗，并且具有预测价值。
