Clinical features of non-diabetic renal diseases in patients with type 2 diabetes
Clinical features of non-diabetic renal diseases in patients with type 2 diabetes
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DOI：
10.1016/j.diabres.2005.02.009
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发表时间：
2005-09-01
影响因子：
5.1
通讯作者：
Makino, H
中科院分区：
文献类型：
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作者：
Tone, A;Shikata, K;Makino, H
持续性蛋白尿是糖尿病肾病（DN）的特征性表现，但在糖尿病蛋白尿患者中，鉴别非糖尿病肾病（NDRD）是非常重要的。为了重新评估糖尿病患者肾活检的指征，我们回顾性分析了97例日本2型糖尿病患者的临床特征和组织学诊断之间的关系，表现为明显的蛋白尿。由于临床上怀疑他们患有NDRD，因此进行了肾活检。根据组织学诊断将患者分为3组：（1）单纯DN组（n = 35），（2）合并NDRD组（n = 16）和非DN组（n = 46）。我们评估了四个临床参数（糖尿病病程、有无糖尿病视网膜病变、镜下血尿和尿沉渣颗粒管型）预测NDRD的特异性和敏感性。糖尿病病程短（< 5年）者敏感性高（75%），特异性高（70%）。糖尿病视网膜病变的敏感性最高（87%），特异性最高（93%）。镜下血尿（56和58%）和颗粒管型（68和47%）的敏感性和特异性较低。我们的研究证实，无视网膜病变和糖尿病病程短是有明显蛋白尿的糖尿病患者进行肾活检的有用临床指征。(c)2005爱思唯尔爱尔兰有限公司保留所有权利。
Although persistent proteinuria is characteristic of diabetic nephropathy (DN), it is important to differentiate non-diabetic renal diseases (NDRD) in diabetic patients with proteinuria. In order to re-evaluate the indications for renal biopsy in the diabetic patients, we retrospectively analyzed the relationship between clinical features and histological diagnosis in 97 Japanese patients with type 2 diabetes manifesting overt proteinuria. Renal biopsy was performed because they were clinically suspected to have NDRD. Patients were divided into three groups according to the histological diagnosis: (1) the DN group (n = 35) had only diabetic lesions, (2) the complicated group (n = 16) had histological changes of NDRD superimposed on DN and (3) the non-DN group (n = 46) had NDRD without diabetic lesions. We evaluated the specificity and sensitivity of four clinical parameters (duration of diabetes, presence or absence of diabetic retinopathy, microscopic hematuria and granular casts as urinary sediments) for the prediction of NDRD. Short duration of diabetes (< 5 years) showed high sensitivity (75%) and specificity (70%). Diabetic retinopathy showed the highest sensitivity (87%) and specificity (93%). The sensitivity and specificity of microscopic hematuria (56 and 58%) and granular casts (68 and 47%) were lower. Our study confirmed that the absence of retinopathy and short duration of diabetes are useful clinical indications for renal biopsy in diabetic patients with overt protemuria. (c) 2005 Elsevier Ireland Ltd. All rights reserved.