Analysis Of Clinical And Pathological Of 42 Cases With Type 2 Diabetes Receiving Renal Biopsy

Objective To investigate the clinical and pathological features of biopsy-proven non-diabetic renal disease(NDRD)in patients with type 2 diabetes(T2DM).Methods Patients with T2 DM who underwent renal biopsy were enrolled in the Department of Nephrology,Lanzhou University Second Hospital from January 2016 to December 2018.Combined with exclusion criteria,42 cases were finally selected for statistical analysis.The patient's clinical,laboratory and histopathological data were collected.Firstly,according to the results of renal biopsy,three groups were defined: group I diabetic nephropathy group(DN group,n=21 cases);group II isolated non-diabetic renal disease group(NDRD group,n=10 cases;group III the non-diabetic renal disease superimposed on diabetic nephropathy(DN with NDRD group,n=11 cases).The relevant influencing factors between the groups were analyzed.Secondly,according to the pathological results,the patients were divided into two groups: group I diabetic nephropathy group(DN group,n=21 cases);group II with or without diabetic nephropathy non-diabetic nephropathy(NDRD group,n=21 cases).To further explore the main influencing factors in patients with NDRD,the ordinal logistic regression method was used to find out the main influencing factors of biopsy-proven NDRD in patients with T2 DM.Results Of the 42 patients with T2 DM who underwent renal biopsy,29 were male(69%),13 were female(31%),and the ratio of male to female was 2.23:1.According to the results of renal biopsy,21 patients(50%)with typical DN,10 patients(23.8%)with NDRD and 11 patients(26.2%)with NDRD.In the DN group,16 patients(76.2%)were male,5 female patients(23.8),males and females were 3.2:1.There were 7 male patients(70%)in the NDRD group,3(30%)female patients,and males and females were 2.33:1.There were 6 male patients(54.5%)in the DN group with NDRD,5 female patients(45.5%),and male and females 1.2:1.The duration of diabetes in the DN group was 10.62±5.54 years.The duration of diabetes in the NDRD group was 4.02±6.81 years.And the duration of diabetes in the DN group with NDRD was 4.36±4.24 years.There were 11 patients(26.19%)with chronic kidney disease(CKD),5 patients(11.9%)with CKD in the DN group,0 patient with CKD in the NDRD group,and in the DN with NDRD group,there were 6 cases(14.29%)with CKD.The proportion of patients with hypertension were 29/42,including 16/21 hypertensive patients in the DN group,7/10 in the NDRD group,and 6/11 in the DN group with NDRD.A total of 13 patients(30.95%)had hyperlipidemia,including 7 patients(16.67%)in DN group;3 patients(7.14%)in NDRD group;and the DN group with NDRD was associated with 3 patients(7.14%).There were 7 patients(16.7%)with hyperuricemia,including 3 patients(7.14%)with hyperuricemia in DN group and 1 patient(2.38%)in NDRD group.The DN group with NDRD was associated with 3 patients(7.14%)with hyperuricemia.Renal pathology of 10 patients with NDRD: 3 cases(30%)of IgA nephropathy,1 case(10%)of membranous nephropathy,2 cases(20%)of focal stage glomerulosclerosis,1 Case(10%)of glomerular micro lesions,2 cases(20%)of mesangial proliferative glomerulonephritis,and focal proliferative purpuric nephritis(10%).Renal pathology of 11 patients of NDRD superimposed on DN: 1 case(DN)with DN complicated with membranous nephropathy,2 cases(18.2%)with renal tubulointerstitial lesions,2 cases(18.2%)with IgA nephropathy,2 cases(18.2%)with focal glomerulosclerosis,1 case(9.1%)with membranous nephropathy,1 case(9.1%)with glomerular micro lesions,and 2 cases with hypertensive renal injury(18.2%).The levels of eGFR,serum albumin and urinary erythrocyte(/HFP)in patients were [73.95(11.99~195.88)(mL/min/1.73 m2)],31.61±6.49(g/L),and [6.15(0.50~270.40)/HFP],respectively.Most patients have active urinary sediment.Compared with DN,the patients with NDRD had shorter diabetic course,higher incidence of hematuria,higher urinary erythrocyte count(/HFP),higher 24-hour urinary protein quantity,lower serum albumin,higher white blood cell count and very low prevalence of diabetic retinopathy.In the logistic analysis of variables,hematuria [OR = 2.749,95% CI(1.380,5.477),p = 0.02] was an independent predictor of NDRD.Conclusion Non-diabetic kidney injury may be present in patients with clinical manifestations of hematuria in T2 DM.Renal biopsy is strongly recommended for patients with T2 DM who are affected by kidney disease.