Non-diabetic glomerular lesions in diabetic kidney disease: clinical predictors and outcome in an Eastern European cohor
- PDF / 1,072,123 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 45 Downloads / 210 Views
NEPHROLOGY - ORIGINAL PAPER
Non‑diabetic glomerular lesions in diabetic kidney disease: clinical predictors and outcome in an Eastern European cohort Otilia Popa1 · Gabriel Stefan1,2 · Cristina Capusa1,2 · Eugen Mandache2 · Simona Stancu1,2 · Nicoleta Petre2 · Gabriel Mircescu1,2 Received: 20 June 2020 / Accepted: 12 October 2020 © Springer Nature B.V. 2020
Abstract Purpose Since patients’ prognosis depends on the lesions identified by kidney biopsy (KB), we aimed to evaluate predictors of non-diabetic kidney disease (NDKD) in diabetic subjects and to assess their kidney outcome as compared to diabetic nephropathy (DN). Methods 180 adults diagnosed by KB with DN (n = 120) or NDKD (n = 60), over a 10 year time-span, were retrospectively included and followed for a mean of 48.1 (95% CI 43.1–53.1) months. Patients with superimposed specific lesions over DN and with steroid-induced diabetes were excluded. The primary endpoint was renal replacement therapy (RRT) initiation. Only subjects who were alive at the end of follow-up (73 with DN and 38 with NDKD) entered the kidney survival analysis. Results Membranous nephropathy (9%) was the most common NDKD. Predictors for NDKD were shorter duration of diabetes (OR 0.88; 95% CI 0.81–0.96, p = 0.004), absence of diabetic retinopathy (OR 0.08; 95% CI 0.01–0.44, p = 0.003), and nephrotic syndrome at presentation (OR 3.55; 95% CI 1.39–9.04, p = 0.008). Subjects with NDKD needed RRT later as those with DN [82 (95% CI 67–97.1) vs. 45 (95% CI 34–56.5) months, p = 0.001]. In an adjusted Cox model, biopsy diagnosed DN independently predicted RRT (OR 4.43; 95% CI 1.54–12.7, p = 0.006). Other predictors were lower eGFR, higher proteinuria, and absence of renin–angiotensin inhibitor therapy. Conclusion As one-third of the investigated subjects had NDKD, and NDKD was associated with a better kidney survival, independently predicted by the type of glomerular lesion, KB appears the most reliable tool to guide therapy and to assess outcome in patients with diabetic kidney disease. Keywords Chronic kidney disease · Diabetes mellitus · Glomerulopathy · Kidney biopsy · Kidney survival · Non-diabetic kidney disease
Introduction Diabetes mellitus (DM) is a frequent, long-standing condition with a prevalence predicted to increase over the next decades [1]. Concurrent kidney involvement was reported in 40% and 30% of patients with type 2 diabetes mellitus and type 1 diabetes mellitus, respectively [2], and is the leading cause of end-stage kidney disease (ESKD) worldwide [1].
* Cristina Capusa [email protected] 1
Nephrology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
“Dr. Carol Davila” Teaching Hospital of Nephrology, 4 Calea Grivitei, sect. 1, Bucharest, Romania
2
Diabetic kidney disease (DKD) is defined by the coexistence of chronic kidney disease (CKD) and type 1 or type 2 DM. Accordingly, DKD comprises diabetic nephropathy (DN) when only specific diabetic lesions are seen at kidney biopsy (KB) and non-diabetic kidney disease (NDKD)
Data Loading...
