Li Mengrui, Chang Dongyuan, Zhao Yiyang, Wu Liang, Tan Ying, Zhao Minghui, Tang Sydney Chi Wai, Chen Min
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
Institute of Nephrology, Peking University, Beijing, China.
J Nephrol. 2024 Nov;37(8):2233-2242. doi: 10.1007/s40620-024-01995-8. Epub 2024 Jul 20.
Urine sediment examination is a time-tested and non-invasive diagnostic tool. This study investigated the characteristics of urine sediment and its association with severity and renal outcomes in diabetic nephropathy (DN) patients.
A total of 201 biopsy-proven diabetic nephropathy patients (according to the pathological classification of diabetic nephropathy proposed by the Renal Pathology Society in 2010) who underwent manual urine sediment microscopic examination were included. We compared the clinicopathological characteristics of diabetic nephropathy patients with and without urinary renal tubular epithelial cells (RTECs) or renal tubular epithelial cell casts. The predictive value of urinary renal tubular epithelial cells or renal tubular epithelial cell casts for renal outcomes in diabetic nephropathy was analyzed.
Fifty of 201 (24.9%) diabetic nephropathy patients had renal tubular epithelial cells or renal tubular epithelial cell casts in urine sediment. Diabetic nephropathy patients with renal tubular epithelial cells or renal tubular epithelial cell casts in urine sediment had a significantly higher level of proteinuria [6.0 (3.1, 9.7) vs. 3.6 (1.8, 6.8) g/24 h, p = 0.001], higher serum creatinine [227.9 (151.6, 338.1) vs. 177.0 (104.4, 288.4) μmol/L, p = 0.016] and lower estimated glomerular filtration rate (eGFR) [25.8 (15.8, 44.8) vs. 35.7 (19.9, 65.0) mL/min/1.73 m, p = 0.025] than those without. Cox regression analysis demonstrated that the presence of urinary renal tubular epithelial cells or renal tubular epithelial cell casts was independently associated with the development of end-stage kidney disease (ESKD) in diabetic nephropathy patients [HR 1.670, 95% CI (1.042, 2.676), p = 0.033]. Adding the presence of urinary renal tubular epithelial cells or renal tubular epithelial cell casts to the predictive model could improve the effectiveness of the model for predicting the risk of ESKD within one year after renal biopsy.
The presence of urinary renal tubular epithelial cells or renal tubular epithelial cell casts was associated with more severe kidney injury and worse renal outcomes in patients with diabetic nephropathy, thus perhaps providing a noninvasive biomarker for predicting diabetic nephropathy.
尿沉渣检查是一种经过长期验证的非侵入性诊断工具。本研究调查了糖尿病肾病（DN）患者尿沉渣的特征及其与疾病严重程度和肾脏结局的关系。
纳入201例经活检证实的糖尿病肾病患者（根据肾脏病理学会2010年提出的糖尿病肾病病理分类），这些患者均接受了手工尿沉渣显微镜检查。我们比较了有和无尿肾小管上皮细胞（RTECs）或肾小管上皮细胞管型的糖尿病肾病患者的临床病理特征。分析了尿肾小管上皮细胞或肾小管上皮细胞管型对糖尿病肾病患者肾脏结局的预测价值。
201例糖尿病肾病患者中有50例（24.9%）尿沉渣中存在肾小管上皮细胞或肾小管上皮细胞管型。尿沉渣中存在肾小管上皮细胞或肾小管上皮细胞管型的糖尿病肾病患者的蛋白尿水平显著更高[6.0（3.1，9.7） vs. 3.6（1.8，6.8）g/24 h，p = 0.001]，血清肌酐水平更高[227.9（151.6，338.1） vs. 177.0（104.4，288.4）μmol/L，p = 0.016]，而估算肾小球滤过率（eGFR）更低[25.8（15.8，44.8） vs. 35.7（19.9，65.0）mL/min/1.73 m²，p = 0.025]。Cox回归分析表明，尿肾小管上皮细胞或肾小管上皮细胞管型的存在与糖尿病肾病患者终末期肾病（ESKD）的发生独立相关[风险比1.670，95%置信区间（1.042，2.676），p = 0.033]。将尿肾小管上皮细胞或肾小管上皮细胞管型的存在纳入预测模型可提高该模型预测肾活检后一年内ESKD风险的有效性。
尿肾小管上皮细胞或肾小管上皮细胞管型的存在与糖尿病肾病患者更严重的肾损伤和更差的肾脏结局相关，因此可能为预测糖尿病肾病提供一种非侵入性生物标志物。
