Clinical characteristics and outcomes of biopsy-proven diabetic nephropathy

Abstract

Kidney damage is common in patients with diabetes mellitus (DM). However, whether the type of kidney damage can be reliably diagnosed using clinical data alone remains unclear. Predictive factors for diabetic nephropathy (DN) outcomes are also poorly understood. In this study, the clinical manifestations of 111 cases of biopsy-proven DN were described, and the clinical and pathological parameters of patients with different DN outcomes were compared. Results showed that long DM duration (>10 years in 32.4% of patients), severe proteinuria (62.2%), and renal dysfunction (estimated glomerular filtration rate [eGFR]<60 mL/(min·1.73 m²)) (52.3%) did not accurately indicate whether the condition of these patients progressed to DN. Hematuria (48.6%) failed to specify either DN or nondiabetic renal disease. Diabetic retinopathy (78.4%) was a crucial complication in patients with DN. Kaplan–Meier analysis revealed that the renal survival of 53 patients who were diagnosed with DN and were followed up was not significantly associated with glomerular classification (P>0.05). Cox’s regression analysis demonstrated that renal survival time was significantly influenced by sex (b= 1.394, P= 0.038), hematuria (b= 0.036, P= 0.029), and eGFR (b= −0.039, P= 0.002) but was not significantly affected by age, 24 h urinary protein excretion, or glomerular classification (P>0.05). In conclusion, the clinical characteristics of DN vary, and renal biopsy is necessary to determine renal damage patterns. Sex, hematuria, and the eGFR may affect DN outcomes, whereas the glomerular classification may not.

Keywords

diabetic nephropathy / clinical characteristics / renal biopsy / outcomes

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Acknowledgements

This work was supported by the Capital Special Research Projects of Health Development (No. 2014-4-4063), China–Japan Friendship Hospital Youth Science and Technology Excellence Project (No. 2015-QNYC-B-12) and Beijing Municipal Science & Technology Commission (Nos. D171100002817003 and D171100002817004).

Compliance with ethics guidelines

Li Zhuo, Nianrong Zhang, Guming Zou, Dapeng Chen, and Wenge Li declare no conflict of interest. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and theHelsinki Declaration of 1975 as revised in 2000. Informed consent was obtained from the patients before they were included in the study.

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