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Characterizing predictors of non-diabetic kidney disease (NDKD) in diabetic patients

  • Nephrology - Original Paper
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Abstract

Background

Diabetic kidney disease (DKD) is the chief cause of renal involvement in diabetic patients. It is primarily a clinical diagnosis. Non-diabetic kidney disease (NDKD) may be missed if they are not biopsied. In this study, we describe the spectrum of NDKD and evaluate the predictors considered for planning a biopsy in diabetic patients with kidney disease.

Methods

In a retrospective cohort study, diabetic patients who underwent kidney biopsy at our centre between May 2006 and July 2019 were evaluated for NDKD.

Results

321 diabetic patients who underwent kidney biopsy were analyzed. Mean age was 49.3 ± 12.4 years and 71% were males. 75.8% patients had hypertension and 25.2% had diabetic retinopathy. Based on the kidney biopsy, patients were classified as DKD-127 (39.6%), NDKD—179(55.8%) and combined DKD + NDKD—15(4.7%). Overall, the most commonly diagnosed pathology was membranous nephropathy-MN (17%), followed by IgA nephropathy (16.0%) and focal segmental glomerulosclerosis-FSGS (14.9%). In patients with DKD + NDKD, IgA nephropathy (53.3%) was predominant. 165 (51.4%) patients had a diagnosis potentially amenable to a specific therapy. On multivariate analysis, female gender [OR 2.07 (1.08–3.97), p = 0.02], absence of diabetic retinopathy [OR 7.47 (3.71–15), p < 0.001] absence of hypertension [OR 3.17 (1.56–6.45), p = 0.001] and duration of diabetes ≤ 24 months [OR 3.67(1.97–6.84), p < 0.001], were independent predictors for NDKD while the absence of nephrotic range proteinuria [OR 1.73 (0.98–3.05), p 0.05] showed a trend towards significance.

Conclusion

Astute use of kidney biopsy can detect potentially treatable NDKD in a large number of diabetic patients with glomerular diseases being the predominant diagnosis. A combination of risk factors needs to be considered to guide the need for kidney biopsy in diabetic patients.

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Data availability

All the data underlying this article are available in the manuscript. If additional data is required it will be shared on reasonable request by the corresponding author.

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Funding

This study has received no funding.

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Author notes

  1. Parmod Mittal

    Present address: CMO NFSG, In-Charge Dialysis and Nephrology, Hindu Rao Hospital and North Delhi Medical College, New Delhi, India

Authors and Affiliations

  1. Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India

    Sana Shadab, Parmod Mittal, Arun Kumar Subbiah, Raj Kanwar Yadav, Sandeep Mahajan, Dipankar Bhowmik, Sanjay Kumar Agarwal & Soumita Bagchi

  2. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

    Adarsh Barwad, Geetika Singh & Amit Dinda

Authors
  1. Sana Shadab
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  2. Parmod Mittal
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  4. Geetika Singh
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  11. Soumita Bagchi
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Contributions

SS—collected and analyzed the data and wrote the manuscript, PM—data collection and analysis, AB, GS and AKD—renal pathologists who reviewed the biopsies, AKS, RKY, SM, DB—patient monitoring, SKA—helped in conceptualizing the study and supervised the manuscript, SB—conceptualized the study, patient monitoring, supervised the data collection and analysis and wrote the manuscript.

Corresponding author

Correspondence to Soumita Bagchi.

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Shadab, S., Mittal, P., Barwad, A. et al. Characterizing predictors of non-diabetic kidney disease (NDKD) in diabetic patients. Int Urol Nephrol 54, 1303–1309 (2022). https://doi.org/10.1007/s11255-021-02998-1

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  • DOI: https://doi.org/10.1007/s11255-021-02998-1

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