Distinguishing Features in Comparing Diabetic Nephropathy with or without Concurrent Non-Diabetic Renal Disease

BACKGROUND: Despite diabetic nephropathy (DN) being the leading cause of end stage renal disease, the incidence and characteristics of non-diabetic renal disease (NDRD) in patients with DN remains unknown. The present study examined the prevalence of NDRD in diabetic patients with kidney involvement and identified differential features between DN with or without coexisting NDRD by comparing clinical manifestations and histopathologic findings. METHODS: We retrospectively reviewed 49 patients that were diagnosed with diabetic nephropathy by renal biopsy. Both the clinical and pathological features were reviewed and recorded. We then compared these patients between with or without coexisting NDRD. RESULTS: In our study, 23 patients (47%) were male and their mean age at the time of biopsy was 53.9 ± 13.2 years. Thirty-seven patients (76%) had typical histological features of DN and 12 patients (24%) had coexisting glomerulopathy. Focal segmental glomerulosclerosis (FSGS) was the most common concurrent NDRD. Both groups had a similar diabetes duration, renal function, and nephrotic range proteinuria. The kidney size of DN was significantly larger than that of with concurrent NDRD. Diabetic retinopathy was more common in the DN group (69% vs. 30%, P ＜ 0.05). Histological examination revealed the Kimmelstiel-Wilson nodule was more frequently observed in DN (56.8% vs. 8.3%, P ＜ 0.01). CONCLUSION: The prevalence of NDRD in diabetic patients is not uncommon. Compared to those with concurrent NDRD, patients with DN had a higher prevalence of diabetic retinopathy and their kidney size was significantly larger. Further, Kimmestiel-Wilson nodule was more commonly observed in the renal tissue of patients with DN. (Acta Nephrologica 2011; 25: 119-124)

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diabetic nephropathy ； Kimmelstiel-Wilson nodule ； glomerulonephritis

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