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BMJ Open Diabetes Res Care. 2017 Aug 11;5(1):e000412. doi: 10.1136/bmjdrc-2017-000412. eCollection 2017.

Presentation, pathology and prognosis of renal disease in type 2 diabetes.

Author information

1
Auckland Diabetes Centre, Green Lane Clinical Centre, Auckland, New Zealand.
2
Department of Renal Medicine, North Shore Hospital, Auckland, New Zealand.
3
Department of Anatomical Pathology, Auckland City Hospital, Auckland, New Zealand.
4
Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand.
5
Department of Renal Medicine, Middlemore Hospital, Auckland, New Zealand.
6
Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.

Abstract

OBJECTIVE:

Non-diabetic renal disease (NDRD) is common in patients with type 2 diabetes (T2D), but the relationship between its presentation and prognosis is unknown.

RESEARCH DESIGN AND METHODS:

In a retrospective cohort study, we compared renal and patient survival among 263 patients with T2D who had native renal biopsies between 2002 and 2008 from three Auckland hospitals in New Zealand. The presence of diabetic nephropathy (DN), NDRD or mixed (DN and NDRD) was determined from biopsy. We examined clinical associations according to NDRD etiologies and mode of presentation-acute (defined by acute kidney injury (AKI)) or non-acute. Patients were followed until end-stage renal disease, death or December 2015. Survival was compared using Log-rank test.

RESULTS:

94 (36%) patients had DN, 72 (27%) had NDRD, and 97 (37%) had mixed pathologies. Obesity-related focal segmental glomerulosclerosis was the most common NDRD (46%) in patients with non-acute presentations, whereas interstitial nephritis or immune-complex glomerulonephritides were the most prevalent in those with acute presentations (60%). DN was commonly associated with AKI (p<0.001). The prevalence of DN increased with diabetes duration (p<0.001), but NDRD was still found in 55% of subjects with ≥14 years T2D. NDRD was strongly associated with the absence of retinopathy (p<0.001). Renal survival was best in the NDRD group (p<0.001). Among those with DN, renal prognosis was worse in those with more advanced DN lesions and those with an acute presentation (p<0.001). The proportion of all-cause mortality was similar in all three groups, but overall survival was poorest in the DN group (p=0.025).

CONCLUSIONS:

Renal disease in patients with T2D is heterogeneous. The renal prognosis differs markedly according to histopathological diagnosis and mode of presentation.

KEYWORDS:

acute kidney injury; end-stage renal disease; focal segmental glomerulosclerosis; type 2 diabetes renal biopsy

Conflict of interest statement

Competing interests: JZ, LJZ, JFC and TC have nothing to declare. MRM is a full-time employee of Baxter Healthcare (Asia-Pacific) Ltd, a part-time employee of University of Auckland as an adjunct associate professor, and a part-time employee of Counties Manukau Health (New Zealand) as a clinical nephrologist.

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