Clinicopathological Correlation Of Type 2 Diabetes With Kidney Disease

Objectives By analyzing the epidemiology of diabetic nephropathy and non-diabetic nephropathy in patients with type 2 diabetes mellitus,to explore important clinical predictors of renal outcome and clinical course,and to look for clinical predictors of NDRD,so as to provide reliable basis for renal biopsy.Methods Retrospectively analyzed the clinicopathological data of 186 patients with renal biopsy for renal disease complicated with T2 DM from January 1,2011 to December 31,2019 in the renal department of the people's hospital of Hebei province.According to the results of renal pathology,they were divided into three groups: DN,NDRD,DN+NDRD,to analyze the correlation between pathology and clinical manifestations,laboratory indicators,to find the predictors of NDRD,and to identify the main differential indicators by logistic regression analysis to establish a differential diagnosis model.Results 1.A total of 186 patients were enrolled in this study population,including DN38(20.4%),NDRD132(71.0%)and DN combined NDRD16(8.6%).Male 113(60.8%)and female 73(39.2%).2.The common pathological types of NDRD in the NDRD and DN+NDRD groups were idiopathic membranous nephropathy(91,61.5%),Ig A nephropathy(14,9.5%)and glomerular minor lesions(14,9.5%).3.Compared with the DN group,the NDRD group usually did not have diabetic retinopathy,with blood urine,short diabetes course,systolic blood pressure,diastolic blood pressure,albumin,urea,creatinine,fasting blood glucose,glycosylated hemoglobin,lower Ig G,and higher hemoglobin,e GFR,24-hour urine protein,complement C3.4.Logistic multivariate regression analysis showed that diabetes mellitus course,systolic pressure,retinopathy,hemoglobin,albumin,fasting blood glucose,hematuria were risk factors for NDRD.5.By calculating the area under the ROC curve and calculating the sensitivity and specificity,the above indexes were statistically significant,among which the hemoglobin diagnostic efficacy was the highest(AUC 0.831),the systolic pressure sensitivity was the highest(97%),and the specificity of albumin and hemoglobin was the same(84.2%).6.By logistic regression analysis,diabetes course,systolic blood pressure,fasting blood glucose,hematuria,diabetic retinopathy,hemoglobin,albumin were taken as the seven main differential indexes,and a differential diagnosis model was established to give the quantitative probability of NDRD.The anti-substitution test showed that the formula have good sensitivity(91.7%)and specificity(92.1%),which could clearly distinguish between NDRD and non-NDRD.Conclusions 1.The pathological types of NDRD in patients with T2 DM complicated with renal disease are diverse,and the most common NDRD is idiopathic membranous nephropathy;2.Systolic blood pressure,duration of diabetes retinopathy,hemoglobin,albumin,fasting glucose,and the microscopic hematuria is one of the important clinical predictors NDRD,but the single index to the diagnosis of NDRD performance is often poor,many factors combined prediction can effectively improve NDRD diagnosis accuracy,according to the logistic regression analysis,establish NDRD and the differential diagnosis of non-NDRD formula has good sensitivity(91.7%)and specificity(92.1%),the NDRD and non-NDRD has a clear distinction,can provide certain evidence for clinical diagnosis.However,it is difficult to distinguish NDRD from non-NDRD only by clinical indicators.If there are no definite contraindications,active renal biopsy should be performed to determine the pathological type.Figure[6];Table[9];Reference[188]...