Clinical indicators which necessitate renal biopsy in type 2 diabetes mellitus patients with renal disease
Clinical indicators which necessitate renal biopsy in type 2 diabetes mellitus patients with renal disease
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DOI：
10.1111/j.1742-1241.2008.01753.x
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发表时间：
2009-08-01
影响因子：
2.6
通讯作者：
Yang, C. -S.
中科院分区：
文献类型：
--
作者：
Lin, Y. -L.;Peng, S. -J.;Yang, C. -S.
背景：糖尿病肾病的诊断总是基于临床依据。然而，2型糖尿病(DM)合并肾脏病变的患者是否有必要进行肾脏活检以确定诊断的必要性仍不清楚。方法：我们对2002年12月至2006年12月期间接受肾活检的50例2型糖尿病患者进行了回顾性研究。根据肾脏病理将患者分为三组：单纯糖尿病肾病组(I组)、合并糖尿病肾病(NDRD)组和单纯糖尿病肾病组(III组)。收集DM>；10年、视网膜病变、既往少量蛋白尿但无突发性大量蛋白尿、无肾小球血尿、非小肾脏等因素，评价其对预测2型糖尿病患者糖尿病肾病或糖尿病视网膜病变的敏感性、特异性、阳性预测值和阴性预测值。结果：糖尿病组24例，糖尿病组15例，糖尿病肾病组11例。急性间质性肾炎是本研究中最常见的继发性肾脏疾病。I组除对无突发性大量蛋白尿(83.3%)和非小肾(95.8%)有较高的敏感性外，其余5项指标的敏感性和特异性均较差。三组之间视网膜病变、突发性大量蛋白尿和血尿相似(p>；0.05)。显著的活检指标包括较高的血清白蛋白、较低的每日尿蛋白排泄量和较低的24小时肌酐清除率(P<；0.05)。结论：我们的研究表明，DM>；10年和视网膜病变不能排除2型DM患者的NDRD，需要进行肾脏活检。高血清白蛋白、低尿蛋白和24 h C(Cr)是排除NDRD的活检指征。
P>Background:The diagnosis of diabetic nephropathy (DN) is always based on clinical grounds. However, the necessity for renal biopsy of type 2 diabetes mellitus (DM) patients with renal disease to establish the diagnosis remains unclear.Methods:We retrospectively studied 50 type 2 diabetic patients performed with renal biopsy between December 2002 and December 2006. Based on renal pathology, patients were divided into group I: DN alone, group II: non-diabetic renal disease (NDRD) superimposed on DN and group III: isolated NDRD. Factors like DM > 10 years, retinopathy, previous minimal proteinuria without sudden heavy proteinuria, no glomerular haematuria and non-small-sized kidney were collected to evaluate their sensitivity, specificity, positive predictive value and negative predictive value for prediction of DN or NDRD in type 2 diabetic patients.Results:Group I consisted of 24 patients, group II 15 patients and group III 11 patients. Acute interstitial nephritis was the most prevalent second renal disease in our study. Sensitivity and specificity for group I was poor in five features except high sensitivity in no sudden heavy proteinuria (83.3%) and non-small-sized kidney (95.8%). Comparable retinopathy, sudden heavy proteinuria and haematuria (p > 0.05) was noted between the three groups. Significant biopsy indicators included higher serum albumin, lower urinary daily protein excretion and lower 24-h creatinine clearance (C(Cr)) rate (p < 0.05).Conclusion:Our study demonstrated that DM > 10 years and retinopathy did not exclude NDRD in type 2 DM patients, and need for renal biopsy. Higher serum albumin, lower urinary daily protein and 24-h C(Cr) were indicative for biopsy to exclude NDRD.