| ObjectiveTo observe the clinicopathological characteristics and prognosis of type 2 diabetic(T2DM)patients with chronic kidney disease(CKD),analyze the predictive factors of the differential diagnosis between diabetic kidney disease(DKD)and non-diabetic kidney disease(NDKD),summarize the experience of Chinese patent medicine in type 2 diabetic patients with chronic kidney disease to provide a reference for identification of NDKD and rational use of Chinese patent medicine.Methodsa retrospective study was used to select the type 2 diabetic patients who underwent renal biopsy in China Japan Friendship Hospital from January 1,2010 to December 31,2018.The patients were divided into DKD group,DKD combined with NDKD group and NDKD group according to the pathological results.The basic information,clinical characteristics,pathological diagnosis,laboratory data,medication information and laboratory data for each subsequent visit after the renal puncture were observed and recorded.The clinical characteristics and terminal events of patients were statistically analyzed To sum up the predictive factors of clinical differentiation between DKD and NDKD,the clinical prognosis of each group,and the medication experience of using Chinese patent medicine to treat type 2 diabetes with chronic kidney disease in China Japan Friendship Hospital.Result:1.This study included 463 patients with type 2 diabetes mellitus and chronic kidney disease,65 in DKD group(14.04%),85 in DKD group(18.36%),and 313 in NDKD group(67.60%).In the NDKD group,IgA nephropathy was the most common pathological type(28.75%),followed by Hepatitis B-virus associated nephritis and membranous nephropathy(20.77%and 16.61%).In the group of DKD combined with NDKD,the most common was Benign arteriolar nephrosclerosis(67.06%),followed by renal tubulointerstitial disease(28.24%)and IgA nephropathy(16.47%).2.According to the logistic regression analysis,the clinical predictors of NDKD group include:no diabetic retinopathy,course of diabetes<6 years,hemoglobin≥120g/L,glomerular hematuria,proteinuria not reaching the scope of nephropathy.No DR had the highest predictive significance(OR,14.902;95%CI,5.989-37.07).3.ACEI/ARB drugs were the most commonly used antihypertensive drugs in this study.Compared with the other two groups,the proportion of antihypertensive drugs alone in the NDKD group was higher,while the other two groups used more than three antihypertensive drugs.The proportion of using insulin in NDKD group was significantly lower than the other two groups.Among the three groups,Huangkui capsule was the most commonly used Chinese patent medicine.There was no difference among the three groups,followed by Cordyceps,haikunshenxi capsule and Niaoduqing granules.Three groups of patients with Chinese patent medicine combination is more common than single use,NDKD single use of Chinese patent medicine was higher while combination of four or more Chinese patent medicine ratio was lower than the other two groups(P<0.001).With the development of CKD,the proportion of Huangkui capsule decreased,the proportion of Niaoduqing granules increased,the proportion of Cordyceps and haikunshenxi capsule in CKD3-4 stage was higher,and it decreased in CKD5 stage.With the development of CKD,the three groups were more inclined to combine Chinese patent medicine,and the types of combination increased with the progress of CKD.4.In this study,the three groups of patients were followed up after renal puncture until October 2019.The number of patients in each group entering end-stage renal disease and renal replacement therapy was 11 cases in the DKD group(28.2%),and 21 cases in the DKD+NDKD group(42.0%),13 cases(6.5%)in the NDKD group.The proportion of patients in the NDKD group entering the end event was significantly less than the other two groups,and the occurrence time was significantly longer(p<0.001).After treatment,the mean value of 24-hour urine protein decreased,the ratio before and after individual increased slightly,the estimated glomerular filtration rate increased,and the overall prognosis was good in NDKD.However,the serum creatinine,urea,estimated glomerular filtration rate,24-hour urine protein and uric acid in DKD group and DKD combined with NDKD group continued to deteriorate,with poor prognosis.Conclusion1.Patients with T2DM and CKD in our hospital underwent renal puncture to diagnose DKD and NDKD when the clinical diagnosis was unclear.IgA nephropathy was the main disease in NDKD.The clinical predictors of NDKD include:no diabetic retinopathy,course of diabetes<6 years,hemoglobin≥ 120g/L,glomerular hematuria,proteinuria not reaching the scope of nephropathy.2.Chinese patent medicine is widely used in chronic kidney disease.The most commonly used drugs are Huangkui capsule,Cordyceps,haikunshenxi capsule and Niaoduqing granules.With the development of CKD,the proportion of Chinese patent medicine has changed. |
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