Department of Nephrology, Government Kilpauk Medical College and Hospital, Chennai, Tamil Nadu, India.
Saudi J Kidney Dis Transpl. 2023 Dec 1;34(Suppl 1):S161-S169. doi: 10.4103/sjkdt.sjkdt_158_22. Epub 2024 Jul 3.
Diabetic nephropathy (DN) is a major complication of diabetes mellitus (DM), leading to end-stage renal disease. A wide spectrum of nondiabetic renal diseases (NDRDs) is reported in type 2 DM. We retrospectively reviewed the medical records of patients with type 2 DM who underwent a kidney biopsy from September 2019 to November 2021 at our center. Patients were grouped as having isolated DN, isolated NDRD, or mixed NDRD with underlying DN. According to the 379 renal biopsies performed during the study period, 57 patients had DM. The prevalence of DN, isolated NDRD, and combined pathologies was 36.8%, 35.1%, and 28.1%, respectively. The most common NDRD was infection-related glomerulonephritis (IRGN) (50.0%), followed by membranous nephropathy (3.0%), focal segmental glomerulosclerosis (10%), pyelonephritis (10%), minimal change disease (1.8%), fibrillary glomerulonephritis (1.8%), and ANCA-associated vasculitis (1.8%). The most common pathological finding of NDRD in the mixed group was IRGN (56.3%), followed by acute tubular injury (31.3%). The duration of DM was significantly shorter (4.8 ± 2.3 years vs. 9.7 ± 3.3 years, P = 0.035) in NDRD patients compared with patients with DN. NDRD was observed in 15% and mixed lesions in 25% of patients, with concomitant diabetic retinopathy (P = 0.029). We conclude that with increasing evidence of NDRD even in patients with DN, careful application of renal biopsies in diabetic patients would assist in the early diagnosis and institution of specific therapy for NDRD to ensure better patient and renal survival.
糖尿病肾病（DN）是糖尿病（DM）的主要并发症，可导致终末期肾病。2 型 DM 患者报道了广泛的非糖尿病性肾脏疾病（NDRD）。我们回顾性分析了 2019 年 9 月至 2021 年 11 月在我院接受肾活检的 2 型 DM 患者的病历。将患者分为孤立性 DN、孤立性 NDRD 或伴有基础 DN 的混合 NDRD。根据研究期间进行的 379 例肾活检，57 例患者患有 DM。DN、孤立性 NDRD 和合并病变的患病率分别为 36.8%、35.1%和 28.1%。最常见的 NDRD 是感染相关肾小球肾炎（IRGN）（50.0%），其次是膜性肾病（3.0%）、局灶节段性肾小球硬化症（10%）、肾盂肾炎（10%）、微小病变性肾病（1.8%）、纤维状肾小球肾炎（1.8%）和抗中性粒细胞胞浆抗体相关性血管炎（1.8%）。混合组中 NDRD 最常见的病理发现是 IRGN（56.3%），其次是急性肾小管损伤（31.3%）。与 DN 患者相比，NDRD 患者的 DM 病程明显更短（4.8±2.3 年 vs. 9.7±3.3 年，P=0.035）。DN 患者中有 15%和混合病变患者中有 25%存在 NDRD，同时伴有糖尿病视网膜病变（P=0.029）。我们得出结论，随着越来越多的证据表明即使在 DN 患者中也存在 NDRD，在糖尿病患者中仔细应用肾活检将有助于早期诊断和实施针对 NDRD 的特定治疗，以确保更好的患者和肾脏生存。
