Non-Diabetic Renal Diseases in Type 2 Diabetic Patients with Renal Involvement: Clinicopathological Study in a Single Medical Center in Taiwan

糖尿病人的非糖尿型腎病變：台灣單一醫學中心之臨床病理研究

賴建賓(Chien-Pin Lai) ； 張家築(Chia-Chu Chang) ； 楊郁(Yu Yang) ； 文耀閣(Yau-Ko Wen) ； 邱炳芳(Pin-Fang Chiou) ； 陳美玲(Mei-Ling Chen) ； Kun-Tu Yeh ； Yet-Ming Lin

《Acta Nephrologica》 24卷3期 (2010/07) Pp. 157-166

摘要

Background and Objective: There has been much debate regarding non-diabetic renal diseases (NDRD) being underdiagnosed among type 2 diabetic patients with renal involvement.
Materials and Methods: We enrolled 168 type 2 diabetic patients receiving renal biopsies in our hospital from 2000 to 2009. Eighty-three patients were excluded mainly due to renal malignancies or severe kidney infections. The remaining 85 cases were retrospectively stratified according to the biopsy results into diabetic nephropathy (DN, mm=18), NDRD (n=33), and DN plus NDRD (n=34) groups. The major reasons for the renal biopsies being performed included acute kidney injury (AKI, including acute deterioration of chronic renal disease), overt proteinuria without retinopathy, and unexplained hematuria. Their associated clinical and laboratory findings were also analyzed.
Results: AKI events accounted for the most causes of biopsy (58.8%). in the AKI group, acute tubulointerstitial nephritis (ATIN) superimposed with DN was the most dominant (44%), followed by isolated ATIN (14%), advanced DN (12%), ATN with nephrosclerosis (4%), and variable glomerulonephritis in minor proportions. ATIN with DN also correlated with regular use of folk remedies compared with isolated DN pathologically (P＜0.05). Dominant pathological features in the atypical proteinuria and unexplained hematuria groups were DN plus membranous nephropathy and DN plus IgA nephropathy, respectively. On clinical assay, red blood cell count in urine, presence of AKI, presence of sub-nephrotic range proteinuria, and absence of retinopathy were statistically significant for NDRD (P＜0.05). In contrast, there are non-significant correlations including age, sex, onset of diabetes, duration of diabetes, serum creatinine level, serum uric acid level, HbAIC, hypertension, neuropathy, and ischemic heart disease.
Conclusions: Our study demonstrated that the above markers may predict the presence of NDRD in diabetes. Among them, use of folk remedies suggested a strong correlation with the presence of ATIN or even end-stage renal disease epidemiologically in Taiwan.

關鍵字

第二型糖尿病 ； 非糖尿型腎病變 ； 腎切片

並列摘要

Background and Objective: There has been much debate regarding non-diabetic renal diseases (NDRD) being underdiagnosed among type 2 diabetic patients with renal involvement.
Materials and Methods: We enrolled 168 type 2 diabetic patients receiving renal biopsies in our hospital from 2000 to 2009. Eighty-three patients were excluded mainly due to renal malignancies or severe kidney infections. The remaining 85 cases were retrospectively stratified according to the biopsy results into diabetic nephropathy (DN, mm=18), NDRD (n=33), and DN plus NDRD (n=34) groups. The major reasons for the renal biopsies being performed included acute kidney injury (AKI, including acute deterioration of chronic renal disease), overt proteinuria without retinopathy, and unexplained hematuria. Their associated clinical and laboratory findings were also analyzed.
Results: AKI events accounted for the most causes of biopsy (58.8%). in the AKI group, acute tubulointerstitial nephritis (ATIN) superimposed with DN was the most dominant (44%), followed by isolated ATIN (14%), advanced DN (12%), ATN with nephrosclerosis (4%), and variable glomerulonephritis in minor proportions. ATIN with DN also correlated with regular use of folk remedies compared with isolated DN pathologically (P＜0.05). Dominant pathological features in the atypical proteinuria and unexplained hematuria groups were DN plus membranous nephropathy and DN plus IgA nephropathy, respectively. On clinical assay, red blood cell count in urine, presence of AKI, presence of sub-nephrotic range proteinuria, and absence of retinopathy were statistically significant for NDRD (P＜0.05). In contrast, there are non-significant correlations including age, sex, onset of diabetes, duration of diabetes, serum creatinine level, serum uric acid level, HbAIC, hypertension, neuropathy, and ischemic heart disease.
Conclusions: Our study demonstrated that the above markers may predict the presence of NDRD in diabetes. Among them, use of folk remedies suggested a strong correlation with the presence of ATIN or even end-stage renal disease epidemiologically in Taiwan.

並列關鍵字

Type 2 diabetes mellitus DM ； non-diabetic renal diseases NDRD ； renal biopsy