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Non-diabetic renal disease in type 2 diabetes mellitus: Study of renal - retinal relationship.

Prakash J, Gupta T, Prakash S, Bhushan P - Indian J Nephrol (2015 Jul-Aug)

Bottom Line: Thus, absence of DR favors NDRD but does not exclude DN because isolated DN was noted in 28.57% cases in absence of DR.Similarly biopsy proven NDRD (pure NDRD; 10% and mixed lesion; 30%) was noted in 40% of cases in presence of DR.In summary, patients with T2DM had higher incidence of NDRD.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

ABSTRACT
Diabetic nephropathy (DN) has become the leading cause of end-stage renal disease worldwide. Non-diabetic renal disease (NDRD), is known to occur in diabetic patients. The renal and retinal relationship in type 2 diabetes mellitus (T2DM) with nephropathy is not uniform. This study was carried to study the histological spectrum of nephropathy in type 2 diabetic patients with proteinuria and its relationship with diabetic retinopathy (DR). Total 31 (males - 26; females - 5) proteinuric type 2 diabetic patients were studied. Average age of patients was 50.7 years. Nephrotic syndrome was noted in 21 (67.7%) patients. Overall, isolated DN, NDRD and NDRD superimposed on DN (mixed lesion) were observed in 12 (38.7%), 13 (41.9%) and 6 (19.4%) cases, respectively. DR was absent in 21/31 (67.7%) cases. The spectrum of nephropathy in patients without DR included: DN in 6 (28.57%), NDRD in 12 (57.14%) and mixed lesion in 3 (14.29%). Kidney histology in patients with DR (n-10) revealed DN in 6 (60%), NDRD in 1 (10%) and mixed lesion in 3 (30%) patients. Thus, absence of DR favors NDRD but does not exclude DN because isolated DN was noted in 28.57% cases in absence of DR. Similarly biopsy proven NDRD (pure NDRD; 10% and mixed lesion; 30%) was noted in 40% of cases in presence of DR. In summary, patients with T2DM had higher incidence of NDRD. DR is less frequent (32.3%) in type 2 diabetes and is a poor predictor of type of nephropathy. Hence, renal biopsy is essential for precise diagnosis of nephropathy in patients with T2DM.

No MeSH data available.


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Type of nephropathy in relation to duration of diabetes (n = 31)
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Figure 2: Type of nephropathy in relation to duration of diabetes (n = 31)

Mentions: We have demonstrated in our study that development of DN takes several years from the diagnosis and/or onset of DM. NDRD versus DN was seen in 12.9% versus 3.2% of cases, respectively with duration of diabetes <4 years. NDRD and DN were observed in 22.6% and 3.2% of patients, respectively with duration of diabetes between 5 and 10 years. We noted DN versus NDRD in 32.2% versus 6.5% of the cases with the duration of diabetes more than 10 years [Figure 2]. Similar observations were made by Sharma et al., in which median duration of DM in patients with NDRD alone was 5 years, which was significantly shorter than in patients with DN alone (13 years) and DN + NDRD (10 years).[27] In multivariate analysis, longer duration of diabetes was associated with a greater likelihood of DN and lower likelihood of NDRD.[27]


Non-diabetic renal disease in type 2 diabetes mellitus: Study of renal - retinal relationship.

Prakash J, Gupta T, Prakash S, Bhushan P - Indian J Nephrol (2015 Jul-Aug)

Type of nephropathy in relation to duration of diabetes (n = 31)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495476&req=5

Figure 2: Type of nephropathy in relation to duration of diabetes (n = 31)
Mentions: We have demonstrated in our study that development of DN takes several years from the diagnosis and/or onset of DM. NDRD versus DN was seen in 12.9% versus 3.2% of cases, respectively with duration of diabetes <4 years. NDRD and DN were observed in 22.6% and 3.2% of patients, respectively with duration of diabetes between 5 and 10 years. We noted DN versus NDRD in 32.2% versus 6.5% of the cases with the duration of diabetes more than 10 years [Figure 2]. Similar observations were made by Sharma et al., in which median duration of DM in patients with NDRD alone was 5 years, which was significantly shorter than in patients with DN alone (13 years) and DN + NDRD (10 years).[27] In multivariate analysis, longer duration of diabetes was associated with a greater likelihood of DN and lower likelihood of NDRD.[27]

Bottom Line: Thus, absence of DR favors NDRD but does not exclude DN because isolated DN was noted in 28.57% cases in absence of DR.Similarly biopsy proven NDRD (pure NDRD; 10% and mixed lesion; 30%) was noted in 40% of cases in presence of DR.In summary, patients with T2DM had higher incidence of NDRD.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

ABSTRACT
Diabetic nephropathy (DN) has become the leading cause of end-stage renal disease worldwide. Non-diabetic renal disease (NDRD), is known to occur in diabetic patients. The renal and retinal relationship in type 2 diabetes mellitus (T2DM) with nephropathy is not uniform. This study was carried to study the histological spectrum of nephropathy in type 2 diabetic patients with proteinuria and its relationship with diabetic retinopathy (DR). Total 31 (males - 26; females - 5) proteinuric type 2 diabetic patients were studied. Average age of patients was 50.7 years. Nephrotic syndrome was noted in 21 (67.7%) patients. Overall, isolated DN, NDRD and NDRD superimposed on DN (mixed lesion) were observed in 12 (38.7%), 13 (41.9%) and 6 (19.4%) cases, respectively. DR was absent in 21/31 (67.7%) cases. The spectrum of nephropathy in patients without DR included: DN in 6 (28.57%), NDRD in 12 (57.14%) and mixed lesion in 3 (14.29%). Kidney histology in patients with DR (n-10) revealed DN in 6 (60%), NDRD in 1 (10%) and mixed lesion in 3 (30%) patients. Thus, absence of DR favors NDRD but does not exclude DN because isolated DN was noted in 28.57% cases in absence of DR. Similarly biopsy proven NDRD (pure NDRD; 10% and mixed lesion; 30%) was noted in 40% of cases in presence of DR. In summary, patients with T2DM had higher incidence of NDRD. DR is less frequent (32.3%) in type 2 diabetes and is a poor predictor of type of nephropathy. Hence, renal biopsy is essential for precise diagnosis of nephropathy in patients with T2DM.

No MeSH data available.


Related in: MedlinePlus