Study Of The Clinical And Pathological Features Of Type 2 Diabetes Mellitus Accompanied By Kidney Impairment

Background:With the improvement of living standard,the incidence of diabetes mellitus was increasing year by year.The incidence of diabetes mellitus in China was less than 1% in 1980.In 2013,the prevalence rate of adult diabetes in China was 11.6%.The incidence of diabetes in China was close to that in developed countries now.As an important target organ of diabetes,kidney has become a major challenge in the field of public health.About 21.3% of diabetic patients were accompanied by chronic kidney disease.Diabetic kidney disease increased diabetes-related mortality and medical expenses,and cardiovascular event deaths in diabetic patients were associated with the development of chronic kidney disease too.Big data showed that diabetic kidney disease has overtaken glomerulonephritis as the most common cause of end-stage renal disease in China.Type 2 diabetes combined with renal damage includes diabetic kidney disease and non-diabetic renal disease.The treatment and prognosis of the two are completely different,so how to distinguish them becomes a challenge for nephrologists.For patients with diabetic glomerulopathy who underwent renal biopsy,the value of the pathological in predicting the prognosis of kidney needs to be further studied.Purpose:The purpose of this study was to investigate the significance of clinical indexes in differentiating type 2 diabetes mellitus with diabetic kidney disease and non-diabetic renal disease,and to evaluate the value of the pathological grading system for diabetic nephropathy in predicting the prognosis of the kidney.Methods:From July 1,2010 to June 31,2018,renal biopsies were performed in the First Hospital of Jilin University in patients with type 2 diabetes mellitus accompanied by renal impairment.The clinical and pathological data of the above patients were collected.The above results were analyzed to explore the predictors of diabetic glomerulopathy and non-diabetic renal disease and a meaningful result was analyzed by meta-analysis.All diabetic glomerulopathy patients were followed up and the follow-up deadline was Oct.1,2018,creatinine doubling and renal replacement therapy were defined as end-point events to explore the value of pathological classification system in judging the prognosis of kidney.Results:According to the results of renal biopsy,they were divided into three groups: diabetic glomerulopathy(DG)group(N = 45)and non-diabetic renal disease(NDRD)group(N = 171),DG+NDRD group(N = 8).Male was predominant(N = 135,60.3%)in this cohort,and most of them were middle-aged and elderly.The incidence of hypertension was 56.3% and the incidence of overload and obesity was 80.4%.The most common pathological types was membranous nephropathy(86/171),followed by IgA nephropathy(31/171)and minimal lesion nephropathy(15/171).History of diabetes ≥ 5 years(OR: 3.042,95%CI: 1.185-7.807,P < 0.05),accompanied by diabetic retinopathy(OR: 10.165,95%CI: 3.498-29.533,P < 0.01),smoking history(OR: 4.388,95%CI: 1.642-11.726,P < 0.01)were predictors for DG.Hemoglobin ≥125g/L(OR: 1.036,95%CI: 1.012-1.061,P < 0.01)was predictor for NDRD.Meta-analysis showed that smoking was an independent risk factor for diabetic kidney disease(OR: 1.7,95% CI: 1.48-1.95).Cox-regression analysis of renal pathology and prognosis showed that the grade of glomerulopathy(RR: 2.353,95% CI: 1.273,4.348,P < 0.01),interstitial fibrosis and tubular atrophy(RR: 2.128,95%CI: 1.068-4.242,P<0.05),and arterial hyalinization(RR: 8.384,95% CI: 3.090,22.750,P < 0.01)were related to creatinine doubling,The grade of glomerulopathy(RR: 4.716,95%CI: 1.048-21.323,P<0.05),interstitial fibrosis and tubular atrophy(RR: 1.889,95%CI: 1.049-41.650,P<0.05)were related to renal replacement therapy.Conclusions:(1)Diabetic retinopathy,the history of diabetes mellitus ≥ 5 years and smoking history are the predictors of diabetic glomerulopathy in patients with type 2 diabetes mellitus with kidney impairment.Hemoglobin ≥ 125g/L is the predictor of non-diabetic renal disease in patients with type 2 diabetes mellitus accompanied by kidney impairment.(2)Glomerulopathy grade,interstitial fibrosis and tubular atrophy,and arterial hyalinization are related to renal prognosis.