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KMID : 0359920130320030115
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Korean Journal of Nephrology
2013 Volume.32 No. 3 p.115 ~ p.120
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Nondiabetic kidney diseases in type 2 diabetic patients
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Kim Ye-Jin
Kim Yoo-Hyung
Kim Ki-Dae
Moon Kang-Ryun
Park Jae-Ho
Park Bo-Mi
Ryu Hye-Won
Choi Dae-Eun
Na Ki-Ryang
Suh Kwang-Sun
Lee Kang-Wook
Shin Young-Tai
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Abstract
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Background: The aim of this study was to evaluate the clinical characteristics of nondiabetic nephropathy in type 2 diabetes mellitus patients and to find a clinical significance of renal biopsy and immunosuppressive treatment in such a patient. Methods: Renal biopsy results, clinical parameters, and renal outcomes were analyzed in 75 diabetic patients who underwent kidney biopsy at Chungnam National University Hospital from January 1994 to December 2010. Results: The three most common reasons for renal biopsy were nephrotic range proteinuria (44%), proteinuria without diabetic retinopathy (20%), and unexplained decline in renal function (20.0%). Ten patients (13.3%) had only diabetic nephropathy(Group I); 11 patients (14.7%) had diabetic nephropathy with superimposed nondiabetic nephropathy (Group II); and 54 patients (72%) had only nondiabetic nephropathy (Group III). Membranous nephropathy (23.1%), IgA nephropathy(21.5%), and acute tubulointerstitial nephritis (15.4%) were the three most common nondiabetic nephropathies. Group III had shorter duration of diabetes and lesser diabetic retinopathy than Groups I and II (P¼0.008). Group II had the lowest baseline estimated glomerular filtration rate (P¼0.002), with the greatest proportion of renal deterioration during follow-up (median 38.0 months, Po0.0001). The patients who were treated with intensive method showed better renal outcomes (odds ratio 4.931; P¼0.01). Absence of diabetic retinopathy was associated with favorable renal outcome in intensive treatment group (odds ratio 0.114; P¼0.032). Conclusion: Renal biopsy should be recommended for type 2 diabetic patients with atypical nephropathy because a considerable number of these patients may have nondiabetic nephropathies. And intensive treatment including corticosteroid or immunosuppressants could be recommended for type 2 diabetic patients with nondiabetic nephropathy, especially if the patients do not have diabetic retinopathy.
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KEYWORD
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Biopsy, Diabetic nephropathy, Immunosuppressive agents, Type 2 diabetes mellitus
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