Korean J Intern Med.  2013 Sep;28(5):565-572. 10.3904/kjim.2013.28.5.565.

Renal outcomes and clinical course of nondiabetic renal diseases in patients with type 2 diabetes

• Byun JM
• Lee CH
• Lee SR
• Moon JY
• Lee SH
• Lee TW
• Ihm CG
• Jeong KH

• KMID: 1780104
• DOI: http://doi.org/10.3904/kjim.2013.28.5.565

Abstract

BACKGROUND/AIMS
In several recent studies, renal biopsies in patients with type 2 diabetes and renal disease have revealed a heterogeneous group of disease entities. Our aim was to study the prognosis and clinical course of nondiabetic renal disease (NDRD) and to determine risk factors for NDRD in patients with type 2 diabetes.
METHODS
Renal biopsy reports of 110 patients with type 2 diabetes who were seen at Kyung Hee University Medical Center and Kyung Hee University Hospital at Gangdong, Seoul, Korea between January 2000 and December 2011 were retrospectively analyzed.
RESULTS
Of 110 patients with type 2 diabetes, 41 (37.3%) had diabetic nephropathy (DN), 59 (53.6%) had NDRD, and 10 (9.1%) had NDRD superimposed on DN. Immunoglobulin A nephropathy (43.5%) was the most common NDRD. Patients with NDRD had a shorter duration of diabetes, lower frequency of diabetic retinopathy, and better renal outcomes, which might have resulted from the use of aggressive disease-specific treatments such as steroids and immunosuppressants in patients with NDRD.
CONCLUSIONS
Compared with DN, NDRD was associated with better renal outcomes in patients with type 2 diabetes, as evidenced by a higher cumulative renal survival rate and lower rate of end-stage renal disease (ESRD). Shorter duration of diabetes and absence of retinopathy were independent predictors of NDRD in patients with type 2 diabetes and renal involvement. Renal biopsy is recommended for patients with type 2 diabetes and risk factors for NDRD, to obtain an accurate diagnosis, prompt initiation of disease-specific treatment, and ultimately better renal outcomes with the avoidance of ESRD.

Keyword

Non-diabetic renal disease; Diabetic nephropathies; Diabetes mellitus, type 2

MeSH Terms

Adult
Biopsy
Chi-Square Distribution
Diabetes Mellitus, Type 2/*complications/diagnosis/therapy
Diabetic Nephropathies/diagnosis/etiology
Disease Progression
Female
Glomerulonephritis, IGA/complications/diagnosis
Hospitals, University
Humans
Kaplan-Meier Estimate
Kidney Diseases/*complications/diagnosis/therapy
Kidney Failure, Chronic/diagnosis/etiology
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Prognosis
Retrospective Studies
Risk Factors
Time Factors