Iranian Journal of Pathology

Clinicopathological Spectrum of Diabetic and Non-diabetic Renal Lesions in Patients with Diabetes Mellitus: An Experience from A Tertiary Care Center

Document Type : Original Research

Authors

Netra Prakash Kori 1
Manjunath Revanasiddappa 2
Nagraj D Naik 2
Atul Desai 2
Ranjana S Ranade 3

1 Department of Pathology, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India

2 Department of Nephrology, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India

3 Department of Pathology, KLE JGMMMC, Hubballi, a unit of KLE Academy of Higher Education and Research, Belagavi, India

https://doi.org/10.30699/ijp.2024.2024462.3270
Abstract
Background & Objective: Diabetic patients often develop lesions called non-diabetic renal diseases (NDRD), whose prognostic and therapeutic implications vary from diabetic nephropathy (DN). Since early identification of NDRD is associated with a better prognosis, we aimed to understand its spectrum.
Methods: One hundred and thirty-four patients were included in a cross-sectional study. Their clinical, and laboratory data and indications for biopsy were recorded. Two cores of renal tissue were studied under light microscopy and immunofluorescence; patients were classified into NDRD, NDRD+DN, and DN groups.
Results: Of all the patients studied, five were diagnosed with type 1 diabetes mellitus (DM1), and the rest were type 2 diabetes mellitus (DM2). Overall, the male-to-female ratio was 3:1. The Mean age of NDRD patients was the greatest, and males were predominant in all three groups. CKD was the most common presentation. Except for significantly greater proteinuria and hematuria in the DN and NDRD groups respectively, others were not different. Infection-related glomerulonephritis was the most common lesion among the NDRD+DN group, whereas IgA nephropathy and acute tubulointerstitial nephritis were frequent in the NDRD group.
Conclusion: Based on our findings, renal biopsy should be considered in all those diabetic patients with lesser onset duration presenting with hematuria, no/minimal retinopathy, and minimal proteinuria. A precise diagnosis helps in providing timely therapy for NDRD and prolonging renal and patient survival.

Keywords

Diabetes Mellitus
DN
NDRD
Renal biopsy
CKD

Subjects

  1. Kanodia KV, Vanikar AV, Nigam L, Patel RD, Suthar KS, Patel H. Clinicopathological study of nondiabetic renal disease in type 2 diabetic patients: A single center experience from India. Saudi J Kidney Dis Transpl. 2017;28(6):1330-1337. [DOI:10.4103/1319-2442.220877] [PMID]
  2. Gomathy S, Samuel U, Deepa KH, Suma TK. Study of Non-Diabetic Kidney Disease in Type2 Diabetic Patients with Renal Involvement. IOSR-JDMS. 2017; 16 (6): 43-50. [DOI:10.9790/0853-1606034350]
  3. Gunnam S, Annapareddy SN. Spectrum of non-diabetic renal disease in patients with diabetes mellitus in a tertiary care hospital. Int J Adv Res Med 2021; 3(2): 224-232. [DOI:10.22271/27069567.2021.v3.i2d.250]
  4. Wilfred DC, Mysorekar VV, Venkataramana RS, Eshwarappa M, Subramanyan R. Nondiabetic renal disease in type 2 diabetes mellitus patients: a clinicopathological study. J Lab Physicians. 2013;5(02): 094-9. [DOI:10.4103/0974-2727.119850] [PMID]
  5. Mak SK, Gwi E, Chan KW, Wong PN, Lo KY, Lee KF, et al. Clinical predictors of non‑diabetic renal disease in patients with non‑insulin dependent Diabetes mellitus. Nephrol Dial Transplant 1997;12:2588‑91. [DOI:10.1093/ndt/12.12.2588] [PMID]
  6. Prakash J, Sen D, Usha, Kumar NS. Non‑diabetic renal disease in patients with type 2 Diabetes mellitus. J Assoc Physicians India 2001;49:415‑20.
  7. Soni SS, Gowrishankar S, Kishan AG, Raman A. Non‑diabetic renal disease in type 2 diabetes mellitus. Nephrology (Carlton) 2006;11:533‑7. [DOI:10.1111/j.1440-1797.2006.00681.x] [PMID]
  8. Lin YL, Peng SJ, Ferng SH, Tzen CY, Yang CS. Clinical indicators which necessitate renal biopsy in type 2 diabetes mellitus patients with renal disease. Int J Clin Pract 2009;63:1167‑76. [DOI:10.1111/j.1742-1241.2008.01753.x] [PMID]
  9. Whittier WL, Korbet SM (2004) Renal biopsy: update. Curr Opin Nephrol Hypertens 13:661-665. [DOI:10.1097/00041552-200411000-00013] [PMID]
  10. Ghani AA, Al Waheeb S, Al Sahow A, Hussain N. Renal biopsy in patients with type 2 diabetes mellitus: indications and nature of the lesions. Ann Saudi Med 2009;29:450-453. [DOI:10.4103/0256-4947.57167] [PMID]
  11. Tervaert TW, Mooyaart AL, Amann K, Cohen AH, Cook HT, Drachenberg CB, et al. Renal Pathology Society. Pathologic classification of diabetic nephropathy. J Am Soc Nephrol. 2010;21(4):556-63. [DOI:10.1681/ASN.2010010010] [PMID]
  12. Martinez-Castelao A, Navarro-Gonzalez JF, Gorriz JL, De Alvaro F. The concept and the epidemiology of diabetic nephropathy have changed in recent years. J Clin Med 2015;4:1207-1216. [DOI:10.3390/jcm4061207] [PMID]  
  13. Gambara V, Mecca G, Remuzzi G, Bertani T. Heterogeneous nature of renal lesions in type II diabetes. J Am SocNephrol 1993;1458-1466. [DOI:10.1681/ASN.V381458] [PMID]
  14. Pham TT, Sim JJ, Kujubu DA, Liu IL, Kumar VA. Prevalence of non-diabetic renal disease in Diabetic patients. Am J Nephrol 2007;27:322‑8. [DOI:10.1159/000102598] [PMID]
  15. Chang TI, Park JT, Kim JK, Kim SJ, Oh HJ, Yoo DE, et al. Renal outcomes in patients with type 2 diabetes with or without coexisting non‑diabetic renal disease. Diabetes Res Clin Pract 2011;92:198‑204. [DOI:10.1016/j.diabres.2011.01.017] [PMID]
  16. Li H, Li XW, Huang QY, Ye WL, Duan L, Li Y. Non‑diabetic renal disease in type II diabetes mellitus. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Acad Med Sinicae 2003;25:101‑4.
  17. Das U, Dakshinamurty KV, Prayaga A, Uppin MS. Nondiabetic kidney disease in type 2 diabetic patients: A single center experience. Indian J Nephrol. 2012;22(5):358-62. [DOI:10.4103/0971-4065.103912] [PMID]
  18. Yaqub S, Kashif W, Hussain SA. Kanodia KV, Vanikar AV, Nigam L, et al. Non-diabetic renal disease in patients with type-2 diabetes mellitus. Saudi J Kidney Dis Transpl 2012;23: 1000-7. [DOI:10.4103/1319-2442.100882] [PMID]
  19. Kittrawee Kritmetapak, Sirirat Anutrakulchai, Chatlert Pongchaiyakul et al. Clinical and pathological characteristics of non-diabetic renal disease in type 2 diabetes patients; Clin Kidney J 2018; 344-5. [DOI:10.1093/ckj/sfx111] [PMID]  
  20. Kumar R, Anandh U, Gowrishankar S, Gupta K, Jadhav S. Nondiabetic Renal Pathology in Biopsies of Type 2 Diabetes Mellitus Patients: Changing Trends and the Clinical Factors Predicting These Lesions. Saudi J Kidney Dis Transpl. 2021;32(4):999-1005. [DOI:10.4103/1319-2442.338313] [PMID]
  21. Eswarappa M, Suryadevara S, Rajashekar R, Gurudev KC, Tyagi P, Avin V. Non-diabetic kidney disease in Diabetic Population: A Single-Center Study From South India. Cureus. 2022 Apr 6;14(4). [DOI:10.7759/cureus.23899] [PMID]  
  22. Lyngdoh BS, Baishya P, Mishra J, Marbaniang E, Dey B. IgA nephropathy superimposed on diabetic nephropathy: A case report with review of literature in eight Indian studies. J Family Med Prim Care. 2021 Jun;10(6):2419-2422. [DOI:10.4103/jfmpc.jfmpc_1962_20] [PMID]
  23. Orfila C., Rakotoarivony J., Manuel Y., Suc J.M. Immunofluorescence characterization of light chains in human nephropathies. Virchows Arch A Pathol Anat Histopathol. 1988;412:591-594. [DOI:10.1007/BF00844295] [PMID]
  24. Parving HH, Gall MA, Skøtt P, Jorgensen HE, Lokkegaard H, Jorgensen F et al. Prevalence and causes of albuminuria in non-insulin‑ dependent diabetic patients. Kidney Int 1992; 41:758‑ 62. [DOI:10.1038/ki.1992.118] [PMID]
  25. Tone A, Shikata K, Matsuda M, Usui H, Okada S, Ogawa D et al. Clinical features of non-diabetic renal diseases in patients with type 2 diabetes. Diabetes Res Clin Pract 2005; 69:237-42. [DOI:10.1016/j.diabres.2005.02.009] [PMID]
  26. Wong TY, Choi PC, Szeto CC, et al. Renal outcome in type 2 diabetic patients with or without coexisting nondiabetic nephropathies. Diabetes Care 2002; 25:900-5. [DOI:10.2337/diacare.25.5.900] [PMID]
  27. Matias P, Viana H, Carvalho F. Diabetes mellitus and renal disease: When to perform a renal biopsy? Port J Nephrol Hypert 2009; 23:167-73
  28. Zhou J, Xiangmei C, Xie Y, Li J, Yamanaka N, Tong X et al. A differential diagnostic model of diabetic and non-diabetic renal diseases. Nephrol Dial Transplant 2008; 23:1940-45. [DOI:10.1093/ndt/gfm897] [PMID]
  29. Liu S, Guo Q, Han H, Cui P, Liu X, Miao L et al. Clinicopathological characteristics of non-diabetic renal disease in patients with type 2 diabetes mellitus in a northeastern Chinese medical center: a retrospective analysis of 273 cases. Int Urol Nephrol. 2016; 48:1691-8. [DOI:10.1007/s11255-016-1331-y] [PMID]
Iranian Journal of Pathology
Volume 19, Issue 3
Summer 2024
Pages 311-317

  • Receive Date 11 March 2024
  • Revise Date 30 April 2024
  • Accept Date 30 April 2024

Home

Guide for Authors

Submit Manuscript

Contact Us