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Keywords

Renal, Spectrum, Biopsy, Diabetes

Abstract

Background: Diabetic nephropathy(DN) is one of the most common causes of End-stage renal disease. Diagnosing Nondiabetic renal disease(NDRD) is important as it leads to a specific change in therapy however, the usefulness of pathological diagnosis in predicting the prognosis of diabetics is still questionable. Materials and Method: This is a combined retrospective and prospective study for a period of 5 years. The biopsies were divided into three subgroups: DN, DN with superimposed NDRD and NDRD. Results: In this study of 109 Type 2 Diabetic patients, 48.6% had DN alone, 29.4% had DN with superimposed NDRD and 22% had NDRD alone. 45% had Diabetes for more than 10 years. The most common indication for renal biopsy was nephrotic syndrome(35.8%). The most common DN with superimposed NDRD and NDRD were tubulointerstitial nephritis(34.4%) and IgA nephropathy(25%). Class III DN(47.2%) was the most common class. Long duration of Diabetes, low eGFR and increased 24-hour urine protein were found to be significant in the mixed group. Low eGFR, increased UPCR were more commonly seen in class IV DN as compared to the other class. 30 patients were dialysis dependent during follow up. Conclusion One third of patients were found to have NDRD. Shorter duration of diabetes, high eGFR and sub nephrotic range proteinuria predicts NDRD over others. It is frequent to discover more than one disease process; hence the study supports the role of renal biopsy in detecting isolated as well as superimposed non-diabetic renal changes in Diabetic Nephropathy and helps in assessing the prognosis and guiding management decision.

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249

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255

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