Risk factors for non-diabetic renal disease in diabetic patients

被引：30

作者：

Bermejo, Sheila ^{[1
,2
]}

Gonzalez, Ester ^{[3
]}

Lopez-Revuelta, Katia ^{[4
]}

Ibernon, Meritxell ^{[5
]}

Lopez, Diana ^{[6
]}

Martin-Gomez, Adoracion ^{[7
]}

Garcia-Osuna, Rosa ^{[8
]}

Linares, Tania ^{[9
]}

Diaz, Montserrat ^{[10
]}

Martin, Nadia ^{[11
]}

Barros, Xoana ^{[11
]}

Marco, Helena ^{[12
]}

Isabel Navarro, Maruja ^{[12
]}

Esparza, Noemi ^{[13
]}

Elias, Sandra ^{[14
]}

Coloma, Ana ^{[15
]}

Roberto Robles, NicolaS ^{[16
]}

Agraz, Irene ^{[17
]}

Poch, Esteban ^{[18
,19
]}

Rodas, Lida ^{[18
,19
]}

Lozano, Victor ^{[18
,19
]}

Fernandez, Beatriz ^{[20
]}

Hernandez, Eduardo ^{[3
]}

Isabel Martinez, Maria ^{[4
]}

Ionela Stanescu, Ramona ^{[4
]}

Moiron, Jose Pelayo ^{[6
]}

Garcia, Nuria ^{[6
]}

Goicoechea, Marian ^{[9
]}

Calero, Francesca ^{[10
]}

Bonet, Josep ^{[12
]}

Galceran, Josep M. ^{[2
]}

Liano, Fernando ^{[14
]}

Pascual, Julio ^{[1
]}

Praga, Manuel ^{[3
]}

Fulladosa, Xavier ^{[21
,22
,23
,24
]}

Jose Soler, Maria ^{[1
,17
]}

机构：

[1] Hosp del Mar, Nephrol Dept, Barcelona, Spain

[2] Fundacio Althaia, Nephrol Dept, Manresa, Spain

[3] Hosp 12 Octubre, Nephrol Dept, Madrid, Spain

[4] Hosp Univ Fdn Alcorcon, Nephrol Dept, Madrid, Spain

[5] Hosp St Joan Despi Moises Broggi, Nephrol Dept, Barcelona, Spain

[6] Clin Univ Navarra, Nephrol Dept, Pamplona, Spain

[7] Hosp Poniente, Nephrol Dept, Almeria, Spain

[8] Hosp Palamos, Nephrol Dept, Girona, Spain

[9] Hosp Univ Gregorio Maranon, Nephrol Dept, Madrid, Spain

[10] Fundacio Puigvert, Nephrol Dept, Barcelona, Spain

[11] Hosp Univ Josep Trueta, Nephrol Dept, Girona, Spain

[12] Hosp Badalona Germans Trias & Pujol, Nephrol Dept, Badalona, Spain

[13] Hosp Univ Insular Gran Canaria, Nephrol Dept, Las Palmas Gran Canaria, Las Palmas, Spain

[14] Hosp Univ Ramon & Cajal, Nephrol Dept, Madrid, Spain

[15] Hosp San Pedro, Nephrol Dept, Logrono, Spain

[16] Hosp Infanta Cristina, Nephrol Dept, Badajoz, Spain

[17] Hosp Valle De Hebron, Nephrol Dept, Barcelona, Spain

[18] Hosp Clin Barcelona, Nephrol Dept, Barcelona, Spain

[19] Univ Barcelona, IDIBAPS, Barcelona, Spain

[20] Fdn Jimenez Diaz, Nephrol Dept, Madrid, Spain

[21] Hosp Bellvitge Princeps Espanya, Nephrol Dept, Barcelona, Spain

[22] Spanish Grp Study Glomerular Dis GLOSEN, Madrid, Spain

[23] Grp Treball Malalties Glomerulars Soc Catalana Ne, Madrid, Spain

[24] Grp Espanol Estudio Nefropatia Diabet GEENDIAB, Santander, Spain

来源：

CLINICAL KIDNEY JOURNAL | 2020年 / 13卷 / 03期

关键词：

chronic kidney disease; diabetes mellitus; diabetic nephropathy; non-diabetic renal disease; renal biopsy; DIFFERENTIAL DIAGNOSTIC MODEL; CLINICAL PREDICTORS; BIOPSY; NEPHROPATHY; PREVALENCE; MELLITUS; SPECTRUM; PATTERNS;

D O I：

10.1093/ckj/sfz177

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background. Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. Methods. Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. Results. In total, 832 patients were included: 621 men (74.6%), mean age of 61.7612.8 years, creatinine was 2.862.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2-5.4) g/24 h. About 39.5% (n = 329) of patients had DN, 49.6% (n = 413) NDRD and 10.8% (n = 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n = 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) = 1.03, 95% CI: 1.02-1.05, P< 0.001], microhaematuria (OR = 1.51, 95% CI: 1.03-2.21, P = 0.033) and absence of diabetic retinopathy (DR) (OR = 0.28, 95% CI: 0.19-0.42, P< 0.001) were independently associated with NDRD. Kaplan-Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P< 0.001) and higher mortality (P = 0.029). In multivariate Cox analyses, older age (P< 0.001), higher serum creatinine (P< 0.001), higher proteinuria (P< 0.001), DR (P = 0.007) and DN (P< 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P< 0.001), peripheral vascular disease (P = 0.002), higher creatinine (P = 0.01) and DN (P = 0.015) were independent risk factors for mortality. Conclusions. The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis.

引用

页码：380 / 388

页数：9

共 45 条

[1] Kidney Disease and Increased Mortality Risk in Type 2 Diabetes [J].

Afkarian, Maryam ;

Sachs, Michael C. ;

Kestenbaum, Bryan ;

Hirsch, Irl B. ;

Tuttle, Katherine R. ;

Hinnmelfarb, Jonathan ;

de Boer, Ian H. .

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2013, 24 (02) :302-308

[2] Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes-2018 [J].

不详 .

DIABETES CARE, 2018, 41 :S105-S118

[3] CKD in diabetes: diabetic kidney disease versus nondiabetic kidney disease [J].

Anders, Hans-Joachim ;

Huber, Tobias B. ;

Isermann, Berend ;

Schiffer, Mario .

NATURE REVIEWS NEPHROLOGY, 2018, 14 (06) :361-377

[4] The current role of renal biopsy in diabetic patients [J].

Bermejo, Sheila ;

Pascual, Julio ;

Jose Soler, Maria .

MINERVA MEDICA, 2018, 109 (02) :116-125

[5] The large spectrum of renal disease in diabetic patients [J].

Bermejo, Sheila ;

Pascual, Julio ;

Jose Soler, Maria .

CLINICAL KIDNEY JOURNAL, 2017, 10 (02) :255-256

[6] Predictive factors for non-diabetic nephropathy in diabetic patients. The utility of renal biopsy [J].

Bermejo, Sheila ;

Jose Soler, Maria ;

Gimeno, Javier ;

Barrios, Clara ;

Rodriguez, Eva ;

Mojal, Sergi ;

Pascual, Julio .

NEFROLOGIA, 2016, 36 (05) :535-544

[7] Nondiabetic Renal Disease in Type 2 Diabetic Patients: A Review of our Experience in 220 Cases [J].

Bi, Huixin ;

Chen, Nanlan ;

Ling, Guanghui ;

Yuan, Shuguang ;

Huang, Guxiang ;

Liu, Ruihong .

RENAL FAILURE, 2011, 33 (01) :26-30

[8] Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher (eGFR <45 mL/min) [J].

Bilo, Henk ;

Coentrao, Luis ;

Couchoud, Cecile ;

Covic, Adrian ;

De Sutter, Johan ;

Drechsler, Christiane ;

Gnudi, Luigi ;

Goldsmith, David ;

Heaf, James ;

Heimburger, Olof ;

Jager, Kitty J. ;

Nacak, Hakan ;

Jose Soler, Maria ;

Van Huffel, Liesbeth ;

Tomson, Charlie ;

Van Laecke, Steven ;

Weekers, Laurent ;

Wiecek, Andrzej ;

Bolignano, Davide ;

Haller, Maria ;

Nagler, Evi ;

Nistor, Ionut ;

van der Veer, Sabine ;

Van Biesen, Wim .

NEPHROLOGY DIALYSIS TRANSPLANTATION, 2015, 30 :1-142

[9] Renal outcomes and clinical course of nondiabetic renal diseases in patients with type 2 diabetes [J].

Byun, Ja Min ;

Lee, Cheol Hyun ;

Lee, Sul Ra ;

Moon, Ju Young ;

Lee, Sang Ho ;

Lee, Tae Won ;

Ihm, Chun Gyoo ;

Jeong, Kyung Hwan .

KOREAN JOURNAL OF INTERNAL MEDICINE, 2013, 28 (05) :565-572

[10] Renal outcomes in patients with type 2 diabetes with or without coexisting non-diabetic renal disease [J].

Chang, Tae Ik ;

Park, Jung Tak ;

Kim, Jwa-Kyung ;

Kim, Seung Jun ;

Oh, Hyung Jung ;

Yoo, Dong Eun ;

Han, Seung Hyeok ;

Yoo, Tae-Hyun ;

Kang, Shin-Wook .

DIABETES RESEARCH AND CLINICAL PRACTICE, 2011, 92 (02) :198-204

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