| Background:Primary membranous nephropathy（pMN）in patients with Type 2 diabetes mellitus（T2DM）is one of the most important pathological types in T2DM complicated with Non-diabetic kidney disease（NDKD）,and it and Type 2 diabetic nephropathy（T2DN）are two independent diseases.The two diseases are quite different in etiology,pathogenesis,pathological features,treatment and prognosis.Not all renal diseases associated with T2DM are T2DN,and pathologically confirmed T2DM with pMN is not rare.Objective:To investigate the clinical characteristics and predictors of pMN and T2DN in patients with T2DM,to analyze the prognosis,and to find the risk factors for poor prognosis.Methods:The pathological data of type 2 diabetic patients with renal injury who were hospitalized in the Department of Nephrology of the First Affiliated Hospital of Dalian Medical University from May 2008 to August 2022 and underwent renal biopsy were collected.According to the results of renal biopsy,the patients were divided into T2DM with pMN group（n=55）and T2DN group（n=86）.The clinical characteristics and clinical predictors were analyzed.The follow-up records of the enrolled patients were followed up,and some of the selected cases had follow-up records.The follow-up time was≥3 months,and the follow-up endpoint was defined as a decrease in estimated glomerular filtration rate（e GFR）of≥30%of baseline value or End-stage renal disease（ESRD）or all-cause death or the follow-up date was up to the last follow-up on December 31,2022.A total of 97 patients were followed up at least once by outpatient,ward or telephone,including T2DM with pMN group（n=37）and T2DN group（n=60）.The follow-up date and serum creatinine at the end of follow-up were collected for prognosis analysis.SPSS 27.0 statistical analysis software was used to analyze the data.Results:1.Baseline clinical characteristics:a total of 141 patients were enrolled.The age of onset was between 20 and 82 years old,including 88 males（62.4%）and 53 females（37.6%）.According to the pathological results of renal biopsy,the patients were divided into T2DM with pMN group（n=55）and T2DN group（n=86）.1.1 There were 55 patients（39.0%）in T2DM with pMN group,male（54.5%）and female（45.5%）,with an average age of（58.36±8.38）years,and most patients（72.7%）were≥55 years old.Diabetic retinopathy（9.1%）,nephrotic syndrome（56.4%）, microscopic hematuria（30.9%）and anemia（25.5%）were less common in the patients with diabetes mellitus[36（3,84）months].1.2 There were 86 cases（61.0%）in the T2DN group,mostly males（67.4%）and females（32.6%）,with an average age of（49.36±13.08）years,and most cases（61.6%）were younger than 55 years.Diabetic retinopathy（54.7%）,nephrotic syndrome（36.0%）,microscopic hematuria（25.6%）and anemia（53.5%）were the most common complications.2.Comparison of data between groups:The age of onset,hemoglobin,triglyceride,total cholesterol,e GFR,α1-microglobulin,microalbumin and urinary transferrin in T2DM with pMN group were significantly higher than those in T2DN group（all P<0.05）.However,glycosylated hemoglobin,serum albumin,serum creatinine,blood urea nitrogen and serum Ig G were significantly lower in the T2DN group than those in the T2DN group（all P<0.05）.3.Renal pathological stage in T2DM with pMN group:stage II was the most（39%）,followed by I-II（36%）.4.Compared with T2DN group,possible predictors of T2DM complicated with pMN:Univariate and multivariate Logistic regression analysis showed that compared with T2DN group,age≥55 years old（OR value:10.709,95%CI:3.248-35.308,P<0.001）,no diabetic retinopathy（OR value:19.345,95%CI:4.681-79.948,P<0.001）,Hba1c≤7%（OR value:7.137,95%CI:2.117-24.062,P=0.002）,baseline glomerular filtration rate>80 ml·min-1·（1.73 m2）-1（OR:13.682,95%CI:3.353-55.834,P<0.001）,nephrosis syndrome（OR:7.070,95%CI:2.029-24.628,P=0.002）were the possible predictors of T2DM with pMN.5.Comparison of prognosis between the two groups:a total of 97 patients were followed up at least once,including 37 cases in the T2DM with pMN group and 60 cases in the T2DN group,and the median follow-up time was similar between the two groups（P>0.05）.The follow-up e GFR in T2DN group was significantly lower than that in T2DM with pMN group（P<0.05）,and the proportion of CKD4-5 stage patients in T2DN group was significantly higher than that in T2DM with pMN group（41.7%vs0.0%,P<0.05）.6.Comparison of the risk of composite endpoint events between the two groups:the proportion of composite endpoint events in T2DM with pMN group was significantly lower than that in T2DN group（5.4%vs 63.3%,P<0.05）.Kaplan-meier survival analysis showed that the incidence of composite endpoint events not reached in T2DM with pMN group was significantly higher than that in T2DN group（Log-rank test 2=19.224,P<0.001）.During the follow-up,there was no death in the two groups.Multivariate Cox regression analysis showed that the risk of composite endpoint events in the T2DN group was significantly higher than that in the T2DM with pMN group （HR:13.640,95%CI:3.160-58.870,P<0.001）.7.Risk factors affecting the prognosis of DN group:the number of positive endpoint events in T2DM with pMN group was insufficient,and univariate and multivariate Cox regression analysis could not be performed in this group,so only the factors affecting the prognosis of T2DN group were analyzed.Univariate and multivariate Cox regression analysis showed that low hemoglobin（HR=0.982,95%CI:0.966-0.997,P=0.023）,high total cholesterol（HR=1.467,95%CI:1.156-1.862,P=0.002）were independent risk factors for the prognosis of T2DN patients.Conclusions:1.The majority of patients with T2DM complicated with pMN were over 55 years old,and the renal pathological stages were mainly in stage II and I-II.Most T2DN patients were younger than 55 years old and male.2.Compared with T2DN group,age≥55 years,no diabetic retinopathy,presenting with nephrotic syndrome,Hba1c≤7%,baseline glomerular filtration rate>80 ml·min-1·（1.73 m2）-1 were possible predictors of T2DM patients with pMN.3.Compared with T2DM with pMN group,the renal prognosis of T2DN group was worse.Low hemoglobin and high total cholesterol are independent risk factors for the prognosis of T2DN patients. |
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