Clinical Predictors of Non-diabetic Renal Disease and Role of Renal Biopsy in Diabetic Patients with Renal Involvement: A Single Centre Review
Clinical Predictors of Non-diabetic Renal Disease and Role of Renal Biopsy in Diabetic Patients with Renal Involvement: A Single Centre Review
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DOI：
10.3109/0886022x.2011.647302
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发表时间：
2012-01-01
期刊：
影响因子：
3
通讯作者：
Tan, Si-Yen
中科院分区：
文献类型：
--
作者：
Chong, Yip-Boon;Keng, Tee-Chau;Tan, Si-Yen
背景：据报道，2型糖尿病（T2 DM）是全球终末期肾病（ESRD）的主要原因。然而，非糖尿病肾病（NDRD）在肾脏受累的T2 DM患者中并不少见。我们的研究旨在检查NDRD在T2 DM中的患病率以及糖尿病肾病（DN）和NDRD的临床标志物，并确定肾活检在T2 DM患者中的作用及其对临床实践的影响。方法：我们对2004年1月至2008年3月进行肾活检的T2 DM患者（n = 110）进行了回顾性分析。结果：活检结果分为三组：I组/单纯DN（62.7%），II组/孤立NDRD（18.2%），III组/混合病变（19.1%）。NDRD的病因依次为急性间质性肾炎、肾小球肾炎、高血压性肾病和急性肾小管坏死。DN的重要临床标志物是糖尿病视网膜病变和糖尿病持续时间较长。对于NDRD，有用的临床标志物包括急性肾衰竭和镜下血尿的存在。在DN亚组中，与马来人和中国人相比，印度人的糖尿病活检持续时间明显较短。结论：NDRD在T2 DM患者中很常见，鉴于其潜在的可治疗性，应考虑对伴有肾病的T2 DM患者进行肾活检，尤其是那些具有非典型特征的患者。
Background: Type 2 diabetes mellitus (T2DM) is reportedly the leading cause of end-stage renal disease (ESRD) worldwide. However, non-diabetic renal diseases (NDRD) are not uncommon among T2DM patients with renal involvement. Our study aimed to examine the prevalence of NDRD in T2DM and clinical markers for diabetic nephropathy (DN) and NDRD and to determine the role of renal biopsy in T2DM patients and its impact on clinical practice. Methods: We conducted a retrospective analysis of T2DM patients in whom renal biopsies were performed from January 2004 to March 2008 (n = 110). Results: Biopsy results were divided into three groups: group I/pure DN (62.7%), group II/isolated NDRD (18.2%), and group III/mixed lesions (19.1%). The causes of NDRD in decreasing order of frequency were acute interstitial nephritis, glomerulonephritides, hypertensive renal disease, and acute tubular necrosis. Significant clinical markers for DN are presence of diabetic retinopathy and longer duration of diabetes. For NDRD, useful clinical markers include the presence of acute renal failure and microscopic hematuria. In the DN subgroup, Indians had significantly shorter duration of diabetes on biopsy compared with Malays and Chinese. Conclusions: NDRD is prevalent in T2DM patients, and given its potentially treatable nature, renal biopsy should be considered in T2DM patients with nephropathy, especially in those with atypical features.