Clinical And Pathological Analysis Of Patients With Type 2 Diabetes Mellitus Complicated With Renal Impairment

Objective: Examining the value of renal biopsy in the diagnosis of type 2diabetes mellitus with renal damage based on the analysis of epidemiological characteristics,clinical and histopathological features in patients with type 2diabetes mellitus complicated with renal damage,providing a theoretical basis for clinical differential diagnosis,prognosis and treatment.Methods: A retrospective analysis based on renal biopsy records of patients with type 2 diabetes from the Department of Nephrology,Second Hospital of Hebei Medical University between January 1,2016 and December31,2017.All patients were categorized into DG group,NDRD Group,and DG+NDRD group,according to pathological results of renal biopsy.The clinical and pathological features were analyzed.Results: In 481 patients with type 2 diabetes,109 patients(22.7%)had diabetic nephropathy(DG),337(70.0%)had non-diabetic nephropathy(NDRD),and 35(7.3%)had non-diabetic nephropathy superimposed on diabetic nephropathy(DG+NDRD).The common pathological types of NDRD were membranous nephropathy(MN)(157 cases,46.58%),hepatitis B associated nephritis(53 cases,15.73%),Ig A nephropathy(34 cases,10.09%).The membranous nephropathy(9 cases,25.7%),hepatitis B associated nephritis(9 cases,25.7%),Ig A nephropathy(9 cases,25.7%)in the DG+NDRD group had the same frequency.Compared with the NDRD group,the DG group had a longer history of diabetes,higher blood pressure,albumin,serum creatinine,fasting blood glucose,glycated hemoglobin,Ig G,and a lower urine protein baseline,e GFR,complement C3.The proportion of patients who visited the hospital due to increased serum creatinine was higher in DG(21.1%)than that of the NDRD(9.5%),and the proportion of patients seeking medical treatment due to edemawas was lower in DG(50.5%)thanthat of the NDRD group(67.4%).NDRD showed a large proportion of nephrotic syndrome,and high incidence of microscopic hematuria.Ig G accumulated in the kidneys of grades III and IV was more than grade I,and there was no difference in the deposition of Ig A,Ig M,C3,and C1 q.Logistic multivariate regression analysis showed that the history of diabetes,hypertension,fasting blood glucose,non-microscopic hematuria,and absence of hyperlipidemia were risk factors for diabetic nephropathy.Conclusion: The clinical and pathological manifestations of type 2diabetes are complex.It is difficult to identify DN and NDRD by clinical indicators alone.Thus the renal biopsy should be recommended when there is no clear contraindication.