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. 2013 Feb 22;18(1):4.
doi: 10.1186/2047-783X-18-4.

Prevalence of diabetic nephropathy complicating non-diabetic renal disease among Chinese patients with type 2 diabetes mellitus

Li Zhuo  1 , Guming Zou, Wenge Li, Jianhua Lu, Wenwen Ren
Affiliations

Prevalence of diabetic nephropathy complicating non-diabetic renal disease among Chinese patients with type 2 diabetes mellitus

Li Zhuo et al. Eur J Med Res. .

Abstract

Background: The incidence of diabetes mellitus (DM) and diabetic nephropathy (DN) have risen rapidly in the past few decades and have become an economic burden to the healthcare system in China. DN is a major complication of DM and is a leading cause of end-stage renal disease (ESRD). The occurrence of non-diabetic renal disease (NDRD) in diabetic patients has been increasingly recognized in recent years. It is generally believed that it is difficult to reverse DN, whereas some cases of NDRD are readily treatable and remittable. However, DN is known to co-exist with NDRD in a poorly defined population of patients with type 2 diabetes mellitus (T2DM). This study estimated the prevalence of co-existing DN and NDRD in Chinese patients.

Methods: Data were retrospectively analyzed from 244 patients with T2DM who had undergone a renal biopsy between January 2003 and December 2011 at the Nephrology Department, China-Japan Friendship Hospital, China. Male patients numbered 151 (61.9%) of the study population. The biopsies were performed because urinary abnormalities or renal function were atypical of a diagnosis of DN. Biopsy samples were examined using light, immunofluorescence (IF) and electron microscopy (EM). Clinical parameters were recorded for each patient at the time of biopsy.

Results: Nineteen of 244 diabetic patients (7.8%) had co-existing DN and NDRD. These patients showed clinical features and pathologic characteristics of DN, including a high prevalence of diabetic retinopathy (89.5%), a long duration of diabetes, increased thickness of the glomerular basement membrane (GBM) and mesangial expansion. However, they also presented with clinical findings which were inconsistent with DN, such as hematuria, rapidly progressive renal failure and marked proteinuria. Immunoglobulin A (IgA) nephropathy was apparent in 10 out of the 19 patients (52.6%), tubulointerstitial lesions were found in four patients (21.1%), membrano-proliferative glomerulonephritis (MPGN) in three patients (15.8%) and membranous nephropathy (MN) in two patients (10.5%).

Conclusion: Retrospective analysis of biopsy data suggests that approximately 8% of Chinese patients with T2DM may have co-existing DN and NDRD. The most common histological diagnosis in our small series was IgA nephropathy.

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Figures

Figure 1
Figure 1
A case with immunoglobulin A (IgA) nephropathy and diabetic nephropathy (DN). (A) Typical mesangial absorbance pattern after labeling with anti-IgA antibody (IF, 200×). (B) The deposits of mainly IgG collected in the basement membrane and appeared in the linear pattern as shown by immunofluorescence (IF, 200×). (C) Mesangial cellularity and matrix increased, and there was a thickening of the glomerular basement membrane (GBM) (PAS, 200×). (D) The electron micrograph demonstrated an increase in small dense deposits in the mesangium and the mesangial matrix. The basement membrane was diffusely thickened due to diabetic involvement (EM, 5000×). DN, diabetic nephropathy; EM, electron microscopy; GBM, glomerular basement membrane; IF, immunofluorescence; IgA, immunoglobulin A; IgG, immunoglobulin G; PAS, periodic acid-Schiff.
Figure 2
Figure 2
A case with chronic tubular interstitial nephritis (TIN) and diabetic nephropathy (DN). (A) Deposits of mainly IgG collected in the basement membrane and appeared in a linear pattern as viewed by immunofluorescence (IF, 200×). (B) (PAS, 100×) and (C) (Masson, 100×) show severe mesangial expansion (Kimmelstiel-Wilson nodules) and severe tubular injury with only minimal cell infiltration in the interstitial area. DN, diabetic nephropathy; IF, immunofluorescence; IgG, immunoglobulin G; PAS, periodic acid-Schiff; TIN, tubular interstitial nephritis.
Figure 3
Figure 3
A case with membrano-proliferative glomerulonephritis (MPGN) and diabetic nephropathy (DN). (A) This silver staining demonstrated a double contour of many basement membranes, with 'tram-tracking', which is characteristic of type I MPGN (PAS, 200×). (B) Prominent subendothelial deposits and mesangial interposition are seen (EM, 5000×) and (C) the basement membrane was thickened due to diabetic involvement (EM, 5000×). DN, diabetic nephropathy; EM, electron microscopy; MPGN, membrano-proliferative glomerulonephritis; PAS, periodic acid-Schiff.
Figure 4
Figure 4
A case with membranous nephropathy (MN) and diabetic nephropathy (DN). (A) Deposits of mainly IgG collected in the basement membrane and appeared as a diffuse granular pattern as shown by immunofluorescence (IF, 200×). (B) Light microscopy showing membranous glomerulonephritis in which the capillary loops were thickened and prominent. Numerous granular dense deposits were located in subepithelial areas (PAS, 200×). (C) Thickened glomerular basement membrane (GBM) with numerous granular, dense deposits located in subepithelial areas (EM, 5000×). DN, diabetic nephropathy; GBM, glomerular basement membrane; IF, immunofluorescence; IgG, immunoglobulin G; MN, membranous nephropathy; PAS, periodic acid-Schiff.
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References

    1. Suzuki Y, Ueno M, Hayashi H, Nishi S, Satou H, Karasawa R, Inn H, Suzuki S, Maruyama Y, Arakawa M. A light microscopic study of glomerulosclerosis in Japanese patients with noninsulin-dependent diabetes mellitus: the relationship between clinical and histological features. Clin Nephrol. 1994;42(3):155–162. - PubMed
    1. Ruggenenti P, Gambara V, Perna A, Bertani T, Remuzzi G. The nephropathy of non-insulin-dependent diabetes: predictors of outcome relative to diverse patterns of renal injury. J Am Soc Nephrol. 1998;9(12):2336–2343. - PubMed
    1. Gambara V, Mecca G, Remuzzi G, Bertani T. Heterogeneous nature of renal lesions in type II diabetes. J Am Soc Nephrol. 1993;3(8):1458–1466. - PubMed
    1. Spijkerman AM, Dekker JM, Nijpels G, Adriaanse MC, Kostense PJ, Ruwaard D, Stehouwer CD, Bouter LM, Heine RJ. Microvascular complications at time of diagnosis of type 2 diabetes are similar among diabetic patients detected by targeted screening and patients newly diagnosed in general practice: the hoorn screening study. Diabetes Care. 2003;26(9):2604–2608. doi: 10.2337/diacare.26.9.2604. - DOI - PubMed
    1. Kramer HJ, Nguyen QD, Curhan G, Hsu CY. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. JAMA. 2003;289(24):3273–3277. doi: 10.1001/jama.289.24.3273. - DOI - PubMed

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