Clinical Study
Clinicopathological features in 507 patients with type 2 diabetes mellitus complicated with chronic kidney disease
Zhu Fengjuan, Luo Jiao, Chen Xiaoqiong, Yang Shaohua, Yang Fang, Jia Nan, Zhou Qiugen, Hou Fanfan
Published 2020-03-15
Cite as Chin J Nephrol, 2020,36(03): 207-213. DOI: 10.3760/cma.j.cn441217-20191029-00041
Abstract
ObjectiveTo analyze the clinicopathological features in diabetic kidney disease (DKD) and non-diabetic kidney disease (NDKD) patients, and provide reference for patients who will receive renal biopsy with diabetes mellitus complicated with chronic kidney disease.
MethodsThe patients with type 2 diabetes mellitus complicated with chronic kidney disease who underwent renal biopsy were collected through the database at the Nanfang Hospital of Southern Medical University from February 2002 to June 2018. According to the results of renal biopsy, they were divided into DKD group and NDKD group (including DKD+NDKD). The clinical manifestations and pathological types were compared between the two groups.
ResultsA total of 507 patients were eventually included in the study. There were 114 cases (22.5%) with DKD and 393 cases (77.5%) with NDKD. Pathologically, the most common pathological types of NDKD were membranous nephropathy (30.0%) and IgA nephropathy (19.1%). Among NDKD patients, 5.6% patients had DKD combing with NDKD. In term of the clinical manifestations, DKD patients had a longer history of diabetes (>1 year, 76.3% vs 36.1%, P<0.001), higher quantity of urinary protein [3.69(1.70, 6.74) g/24 h vs 2.21(0.91, 4.97) g/24 h, P<0.001], higher serum creatinine [117.5(85.8, 194.5) μmol/L vs 89.0(68.0, 143.8) μmol/L, P<0.001] than NDKD patients. But the hemoglobin [(105.07±20.85) g/L vs (124.41±25.02) g/L, P=0.002] and cholesterol [(5.69±1.87) mmol/L vs (6.43±2.75) mmol/L, P=0.001] in DKD patients were lower than those in NDKD patients. Logistic regression analysis showed that diabetes mellitus history (OR=4.162, 95%CI 1.717-10.098, P=0.002) , higer systolic pressure (every 1 mmHg, OR=1.028, 95%CI 1.011-1.045, P=0.001) , history of antihypertensive medication (OR=3.141, 95%CI 1.496-6.591, P=0.002), diabetic retinopathy (OR=5.561, 95%CI 2.361-13.100, P<0.001) and higher glycated hemoglobin level (every 1%, OR=1.680, 95%CI 1.333-2.118, P<0.001) were related factors of DKD, while hematuria (OR=2.781, 95%CI 1.334-5.798, P=0.006) and higher hemoglobin level (every 1 g/L, OR=1.022, 95%CI 1.008-1.037, P=0.002) were related factors of NDKD.
ConclusionsThere are differences in clinical manifestations and pathological types between DKD and NDKD. The history of diabetes, antihypertensive medication, fundus examination, higher of proteinuria and glycosylated hemoglobin may predict DKD, while hematuria and higher level of hemoglobin may have certain guiding significance for the diagnosis of NDKD. The indication of renal biopsy in patients with diabetes mellitus complicated with chronic kidney disease should include comprehensive clinical manifestations.
Key words:
Diabetes mellitus; Diabetic nephropathies; Biopsy; Non-diabetic nephropathy; Clinical manifestation; Pathological type
Contributor Information
Zhu Fengjuan
Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Luo Jiao
Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Chen Xiaoqiong
First Clinical Medical Institute of Southern Medical University, Guangzhou 510515, China
Yang Shaohua
Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Yang Fang
Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Jia Nan
Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Zhou Qiugen
Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Hou Fanfan
Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China