Skip to main content
SpringerLink
Log in

Nondiabetic Renal Disease (NDRD) and Diabetic Kidney Disease (DKD)

  • Chapter
  • First Online:
Diabetic Kidney Disease

  • 602 Accesses

Abstract

Recently, clinicopathological features in diabetic kidney disease (DKD) are getting more complicated and heterogeneous. In general, renal biopsy in patients with diabetes is performed to differentiate from nondiabetic renal disease (NDRD). Because of the unstandardized indication of renal biopsy in patients with diabetes, little is unknown about what NDRDs are likely superimposed on DN and what kind of clinical manifestations are actually useful to differentiate NDRDs. Here, several key results for these clinical questions are summarized based on the previous studies of biopsy-proven diabetic nephropathy (DN) and NDRD.

According to the recent meta-analysis of 48 studies, the most common NDRD in diabetic patients may be Immunoglobulin A nephropathy in Asian countries, whereas focal-segmental glomerulosclerosis (FSGS) in other countries, especially the United States. The prevalence of DN, NDRD, and mixed forms (DN + NDRD) was extremely variable, ranging from 6.5 to 94%, 3 to 82.9%, and 4 to 45.5% of the overall diagnosis, respectively. Renal prognosis of DN is worse compared with that of NDRD alone, while the renal prognosis of mixed forms is variable. On the other hand, patients with NDRD alone had the best renal prognosis, which might reflect that detection of NDRD by renal biopsy leads to the subsequent successful treatment to NDRD.

With respect to the determinants for discriminating NDRD from DN alone, short duration of DM, absence of diabetic retinopathy, and presence of hematuria can be useful. In addition, these factors combined might further improve the prediction performance.

However, almost all of these results were derived from clinical biopsy studies, and the indication of renal biopsy was variable, which may suggest that most cases of DN alone in these studies were regarded as “atypical” and “need for renal biopsy” by each institution. Therefore, it might be difficult to apply these results to the clinical practice in all diabetic patients. Further investigation of research biopsy with large number of diabetic patients in multicenter is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Caramori ML. Should all patients with diabetes have a kidney biopsy? Nephrol Dial Transplant. 2017;32:3–5.

    Article  Google Scholar 

  2. Fiorentino M, Bolignano D, Tesar V, Pisano A, Biesen WV, Tripepi G, D’Arrigo G, Gesualdo L. Group E-EIW: renal biopsy in patients with diabetes: a pooled meta-analysis of 48 studies. Nephrol Dial Transplant. 2017;32:97–110.

    Article  CAS  Google Scholar 

  3. Plantinga LC, Crews DC, Coresh J, Miller ER 3rd, Saran R, Yee J, Hedgeman E, Pavkov M, Eberhardt MS, Williams DE, Powe NR. Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes. Clin J Am Soc Nephrol. 2010;5:673–82.

    Article  Google Scholar 

  4. Fioretto P, Caramori ML, Mauer M. The kidney in diabetes: dynamic pathways of injury and repair. The Camillo Golgi Lecture 2007. Diabetologia. 2008;51:1347–55.

    Article  CAS  Google Scholar 

  5. Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032–45.

    Article  CAS  Google Scholar 

  6. Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, Hu FB. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301:2129–40.

    Article  CAS  Google Scholar 

  7. Mise K, Hoshino J, Ubara Y, Sumida K, Hiramatsu R, Hasegawa E, Yamanouchi M, Hayami N, Suwabe T, Sawa N, Fujii T, Ohashi K, Hara S, Takaichi K. Renal prognosis a long time after renal biopsy on patients with diabetic nephropathy. Nephrol Dial Transplant. 2014;29:109–18.

    Article  CAS  Google Scholar 

  8. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med. 1993;329:1456–62.

    Article  CAS  Google Scholar 

  9. Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, Remuzzi G, Snapinn SM, Zhang Z, Shahinfar S. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861–9.

    Article  CAS  Google Scholar 

  10. Wanner C, Inzucchi SE, Lachin JM, Fitchett D, von Eynatten M, Mattheus M, Johansen OE, Woerle HJ, Broedl UC, Zinman B, EMPA-REG OUTCOME Investigators. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. 2016;375:323–34.

    Article  CAS  Google Scholar 

  11. Mann JFE, Orsted DD, Brown-Frandsen K, Marso SP, Poulter NR, Rasmussen S, Tornoe K, Zinman B, Buse JB, Leader Steering Committee and Investigators. Liraglutide and renal outcomes in type 2 diabetes. N Engl J Med. 2017;377:839–48.

    Article  CAS  Google Scholar 

  12. Furuichi K, Shimizu M, Yuzawa Y, Hara A, Toyama T, Kitamura H, Suzuki Y, Sato H, Uesugi N, Ubara Y, Hoshino J, Hisano S, Ueda Y, Nishi S, Yokoyama H, Nishino T, Kohagura K, Ogawa D, Mise K, Shibagaki Y, Kimura K, Haneda M, Makino H, Matsuo S, Wada T, Research Group of Diabetic Nephropathy and Nephrosclerosis tMoH, Labour and Welfare, and the Japan Agency for Medical Research and Development. Nationwide multicenter kidney biopsy study of Japanese patients with hypertensive nephrosclerosis. Clin Exp Nephrol. 2018;22:629–37.

    Article  Google Scholar 

  13. Zhuo L, Ren W, Li W, Zou G, Lu J. Evaluation of renal biopsies in type 2 diabetic patients with kidney disease: a clinicopathological study of 216 cases. Int Urol Nephrol. 2013;45:173–9.

    Article  Google Scholar 

  14. Nicholas SB. Structural predictors of renal function decline. Clin J Am Soc Nephrol. 2016;11:202–4.

    Article  CAS  Google Scholar 

  15. Mise K, Hoshino J, Ueno T, Hazue R, Hasegawa J, Sekine A, Sumida K, Hiramatsu R, Hasegawa E, Yamanouchi M, Hayami N, Suwabe T, Sawa N, Fujii T, Hara S, Ohashi K, Takaichi K, Ubara Y. Prognostic value of tubulointerstitial lesions, urinary N-acetyl-beta-d-glucosaminidase, and urinary beta2-microglobulin in patients with type 2 diabetes and biopsy-proven diabetic nephropathy. Clin J Am Soc Nephrol. 2016;11:593–601.

    Article  CAS  Google Scholar 

  16. Anders HJ, Huber TB, Isermann B, Schiffer M. CKD in diabetes: diabetic kidney disease versus nondiabetic kidney disease. Nat Rev Nephrol. 2018;14:361–77.

    Article  CAS  Google Scholar 

  17. Wang J, Han Q, Zhao L, Zhang J, Wang Y, Wu Y, Wang T, Zhang R, Grung P, Xu H, Liu F. Identification of clinical predictors of diabetic nephropathy and non-diabetic renal disease in Chinese patients with type 2 diabetes, with reference to disease course and outcome. Acta Diabetol. 2019;56:939–46.

    Article  Google Scholar 

  18. Hsieh JT, Chang FP, Yang AH, Tarng DC, Yang CY. Timing of kidney biopsy in type 2 diabetic patients: a stepwise approach. BMC Nephrol. 2020;21:131.

    Article  Google Scholar 

  19. Tan J, Zwi LJ, Collins JF, Marshall MR, Cundy T. Presentation, pathology and prognosis of renal disease in type 2 diabetes. BMJ Open Diabetes Res Care. 2017;5:e000412.

    Article  Google Scholar 

  20. Oh SW, Kim S, Na KY, Chae DW, Kim S, Jin DC, Chin HJ. Clinical implications of pathologic diagnosis and classification for diabetic nephropathy. Diabetes Res Clin Pract. 2012;97:418–24.

    Article  Google Scholar 

  21. Chang TI, Park JT, Kim JK, Kim SJ, Oh HJ, Yoo DE, Han SH, Yoo TH, Kang SW. Renal outcomes in patients with type 2 diabetes with or without coexisting non-diabetic renal disease. Diabetes Res Clin Pract. 2011;92:198–204.

    Article  Google Scholar 

  22. Sharma SG, Bomback AS, Radhakrishnan J, Herlitz LC, Stokes MB, Markowitz GS, D’Agati VD. The modern spectrum of renal biopsy findings in patients with diabetes. Clin J Am Soc Nephrol. 2013;8:1718–24.

    Article  Google Scholar 

  23. Tone A, Shikata K, Matsuda M, Usui H, Okada S, Ogawa D, Wada J, Makino H. Clinical features of non-diabetic renal diseases in patients with type 2 diabetes. Diabetes Res Clin Pract. 2005;69:237–42.

    Article  CAS  Google Scholar 

  24. Zhou J, Chen X, Xie Y, Li J, Yamanaka N, Tong X. A differential diagnostic model of diabetic nephropathy and non-diabetic renal diseases. Nephrol Dial Transplant. 2008;23:1940–5.

    Article  Google Scholar 

  25. Chong YB, Keng TC, Tan LP, Ng KP, Kong WY, Wong CM, Cheah PL, Looi LM, Tan SY. Clinical predictors of non-diabetic renal disease and role of renal biopsy in diabetic patients with renal involvement: a single centre review. Ren Fail. 2012;34:323–8.

    Article  Google Scholar 

  26. Fong DS, Aiello L, Gardner TW, King GL, Blankenship G, Cavallerano JD, Ferris FL 3rd, Klein R. Retinopathy in diabetes. Diabetes Care. 2004;27(Suppl 1):S84–7.

    Article  Google Scholar 

  27. Zhang L, Chen B, Tang L. Metabolic memory: mechanisms and implications for diabetic retinopathy. Diabetes Res Clin Pract. 2012;96:286–93.

    Article  CAS  Google Scholar 

  28. Shimizu M, Furuichi K, Toyama T, Kitajima S, Hara A, Kitagawa K, Iwata Y, Sakai N, Takamura T, Yoshimura M, Yokoyama H, Kaneko S, Wada T. Long-term outcomes of Japanese type 2 diabetic patients with biopsy-proven diabetic nephropathy. Diabetes Care. 2013;36:3655–62.

    Article  CAS  Google Scholar 

  29. Yamanouchi M, Mori M, Hoshino J, Kinowaki K, Fujii T, Ohashi K, Furuichi K, Wada T, Ubara Y. Retinopathy progression and the risk of end-stage kidney disease: results from a longitudinal Japanese cohort of 232 patients with type 2 diabetes and biopsy-proven diabetic kidney disease. BMJ Open Diabetes Res Care. 2019;7:e000726.

    Article  Google Scholar 

  30. Suzuki D, Takano H, Toyoda M, Umezono T, Uehara G, Sakai T, Zhang SY, Mori Y, Yagame M, Endoh M, Sakai H. Evaluation of renal biopsy samples of patients with diabetic nephropathy. Intern Med. 2001;40:1077–84.

    Article  CAS  Google Scholar 

  31. Jiang S, Wang Y, Zhang Z, Dai P, Yang Y, Li W. Accuracy of hematuria for predicting non-diabetic renal disease in patients with diabetes and kidney disease: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2018;143:288–300.

    Article  Google Scholar 

  32. Bi H, Chen N, Ling G, Yuan S, Huang G, Liu R. Nondiabetic renal disease in type 2 diabetic patients: a review of our experience in 220 cases. Ren Fail. 2011;33:26–30.

    Article  Google Scholar 

  33. Mise K, Hoshino J, Ueno T, Hazue R, Sumida K, Hiramatsu R, Hasegawa E, Yamanouchi M, Hayami N, Suwabe T, Sawa N, Fujii T, Hara S, Ohashi K, Takaichi K, Ubara Y. Clinical and pathological predictors of estimated GFR decline in patients with type 2 diabetes and overt proteinuric diabetic nephropathy. Diabetes Metab Res Rev. 2015;31:572–81.

    Article  CAS  Google Scholar 

  34. Mise K, Hoshino J, Ueno T, Sumida K, Hiramatsu R, Hasegawa E, Yamanouchi M, Hayami N, Suwabe T, Sawa N, Fujii T, Hara S, Ohashi K, Takaichi K, Ubara Y. Clinical implications of linear immunofluorescent staining for immunoglobulin G in patients with diabetic nephropathy. Diabetes Res Clin Pract. 2014;106:522–30.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Koki Mise

Authors
  1. Koki Mise
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Koki Mise .

Editor information

Editors and Affiliations

  1. Department of Nephrology and Laboratory, Kanazawa University, Kanazawa, Ishikawa, Japan

    Takashi Wada

  2. Department of Nephrology, Kanazawa Medical University, Kanazawa, Ishikawa, Japan

    Kengo Furuichi

  3. Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Okayama, Japan

    Naoki Kashihara

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mise, K. (2021). Nondiabetic Renal Disease (NDRD) and Diabetic Kidney Disease (DKD). In: Wada, T., Furuichi, K., Kashihara, N. (eds) Diabetic Kidney Disease. Springer, Singapore. https://doi.org/10.1007/978-981-15-9301-7_12

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-9301-7_12

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-9300-0

  • Online ISBN: 978-981-15-9301-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation