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International Urology and Nephrology

, Volume 45, Issue 1, pp 173–179 | Cite as

Evaluation of renal biopsies in type 2 diabetic patients with kidney disease: a clinicopathological study of 216 cases

  • Li Zhuo
  • Wenwen Ren
  • Wenge LiEmail author
  • Guming Zou
  • Jianhua Lu
Nephrology – Original Paper

Abstract

Objectives

The outcome and the therapy of patients with diabetes mellitus (DM), diabetic nephropathy (DN), and non-diabetic renal disease (NDRD) are quite different, so the differential diagnosis is of considerable importance. To evaluate the usefulness of renal biopsy in type 2 diabetic patients, we examined the relationship between the clinical parameters and the histopathological findings in different age groups.

Methods

Renal biopsy specimens and clinical and laboratory data from 216 patients with type 2 DM were evaluated. According to their age, three groups were defined: 17–35 years (group I), 36–59 years (group II), and more than 60 years (group III).

Results

The study showed that, beside the duration of diabetes, other clinical parameters were not significantly different between the three groups. Chronic nephritic syndrome was the most common clinical manifestation in group I (44.1 %) and in group II (34.0 %). Among patients in group III, we found a high prevalence of chronic renal failure (34.3 %) and nephrotic syndrome (28.6 %). Consistent with the clinical manifestations, IgA nephropathy was the most common pathologic finding in group I (29.4 %) and in group II (34.7 %), whereas the most frequent abnormalities in group III were membranous nephropathy (25.7 %) and tubulointerstitial lesions (14.3 %). Overall, among these patients, 14 cases were diagnosed with DN (6.5 %), 179 with NDRD (82.9 %), while 23 had concurrent DN and NDRD (10.7 %).

Conclusions

Our results indicated that the clinical manifestations and pathologic findings in type 2 diabetic patients in different age groups have different features. This study emphasized the usefulness of renal biopsy for determining the pattern of renal damage and thus for the overall management of type 2 diabetic patients.

Keywords

Type II diabetes mellitus Diabetic nephropathy (DN) Non-diabetic renal disease (NDRD) Renal biopsy Renal histopathology Age 

Notes

Acknowledgments

This work was supported by the National Natural Science Foundation of China (81170675), the Science Foundation of Chinese-Japanese Friendship Hospital (2010-ZD-05) and Postdoctoral Science Foundation of China (20090450200).

Conflict of interest

We have had no involvements that might raise the question of bias in the work reported or in the conclusions, implications, or opinions stated. The results presented in this paper have not been published previously in whole or part.

References

  1. 1.
    Cavallo T, Pinto JA, Rajaraman S (1984) Immune complex disease complicating diabetic glomerulosclerosis. Am J Nephrol 4:347–354PubMedCrossRefGoogle Scholar
  2. 2.
    Soni SS, Gowrishankar S, Kishan AG, Raman A (2006) Non diabetic renal disease in type 2 diabetes mellitus. Nephrology (Carlton) 11:533–537CrossRefGoogle Scholar
  3. 3.
    Association C (2004) The suggestion on Chinese metabolic syndrome. Chinese Medical Association, ShanghaiGoogle Scholar
  4. 4.
    Wolf G, Schanze A, Stahl RA, Shankland SJ, Amann K (2005) p27(Kip1) Knockout mice are protected from diabetic nephropathy: evidence for p27(Kip1) haplotype insufficiency. Kidney Int 68:1583–1589PubMedCrossRefGoogle Scholar
  5. 5.
    Pugliese G, Pricci F, Barsotti P et al (2005) Development of diabetic nephropathy in the Milan normotensive strain, but not in the Milan hypertensive strain: possible permissive role of hemodynamics. Kidney Int 67:1440–1452PubMedCrossRefGoogle Scholar
  6. 6.
    Olson JL, Wilson SK, Heptinstall RH (1986) Relation of glomerular injury to preglomerular resistance in experimental hypertension. Kidney Int 29:849–857PubMedCrossRefGoogle Scholar
  7. 7.
    Raij L, Azar S, Keane W (1984) Mesangial immune injury, hypertension, and progressive glomerular damage in Dahl rats. Kidney Int 26:137–143PubMedCrossRefGoogle Scholar
  8. 8.
    Lin YL, Peng SJ, Ferng SH, Tzen CY, Yang CS (2009) Clinical indicators which necessitate renal biopsy in type 2 diabetes mellitus patients with renal disease. Int J Clin Pract 63:1167–1176PubMedCrossRefGoogle Scholar
  9. 9.
    Gross JL, de Azevedo MJ, Silveiro SP et al (2005) Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care 28:164–176PubMedCrossRefGoogle Scholar
  10. 10.
    Lee EY, Chung CH, Choi SO (1999) Non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus. Yonsei Med J 40:321–326PubMedGoogle Scholar
  11. 11.
    Nzerue CM, Hewan-Lowe K, Harvey P et al (2000) Prevalence of non-diabetic renal disease among African-American patients with type II diabetes mellitus. Scand J Urol Nephrol 34:331–335PubMedCrossRefGoogle Scholar
  12. 12.
    Jalalah SM (2008) Non-diabetic renal disease in diabetic patients. Saudi J Kidney Dis Transpl 19:813–816PubMedGoogle Scholar
  13. 13.
    Suzuki D, Takano H, Toyoda M et al (2001) Evaluation of renal biopsy samples of patients with diabetic nephropathy. Intern Med 40:1077–1084PubMedCrossRefGoogle Scholar
  14. 14.
    Suzuki Y, Ueno M, Hayashi H et al (1994) A light microscopic study of glomerulosclerosis in Japanese patients with noninsulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol 42:155–162PubMedGoogle Scholar
  15. 15.
    Okada T, Nagao T, Matsumoto H et al (2012) Histological predictors for renal prognosis in diabetic nephropathy in diabetes mellitus type 2 patients with overt proteinuria. Nephrology (Carlton) 17:68–75CrossRefGoogle Scholar
  16. 16.
    Haddiya I, Hamzaoui H, Al Hamany Z et al (2010) Isolated non diabetic renal disease in diabetic patients: a Moroccan report. Saudi J Kidney Dis Transpl 21:555–558PubMedGoogle Scholar
  17. 17.
    Zhou J, Chen X, Xie Y et al (2008) A differential diagnostic model of diabetic nephropathy and non-diabetic renal diseases. Nephrol Dial Transpl 23:1940–1945CrossRefGoogle Scholar
  18. 18.
    Hironaka K, Makino H, Ikeda S, Haramoto T, Ota Z (1991) Nondiabetic renal disease complicating diabetic nephropathy. J Diabet Complicat 5:148–149CrossRefGoogle Scholar
  19. 19.
    Mak SK, Gwi E, Chan KW et al (1997) Clinical predictors of non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus. Nephrol Dial Transpl 12:2588–2591CrossRefGoogle Scholar
  20. 20.
    Yu XQ, Wei JL (2009) Kidney disease in China: recent progress and prospects. Chin Med J (Engl) 122:2048–2053Google Scholar
  21. 21.
    Coppo R, Amore A, Hogg R, Emancipator S (2000) Idiopathic nephropathy with IgA deposits. Pediatr Nephrol 15:139–150PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2012

Authors and Affiliations

  • Li Zhuo
    • 1
  • Wenwen Ren
    • 1
  • Wenge Li
    • 1
    Email author
  • Guming Zou
    • 1
  • Jianhua Lu
    • 1
  1. 1.Department of NephrologyChinese-Japanese Friendship HospitalHepingli, BeijingPeople’s Republic of China

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