Renal pathological implications in type 2 diabetes mellitus patients with renal involvement
Abstract Aims To investigate the renal pathological implications in type 2 diabetes mellitus patients with renal involvement. Methods A total of 328 type 2 diabetes mellitus (T2DM) patients with renal involvement who underwent a renal biopsy and received follow-up for at least one year were recruite...
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| creator | Li, Li Zhang, Xiuhui Li, Zhicheng Zhang, Rui Guo, Ruikun Yin, Qinghua Yang, Lichuan Yue, Rongzheng Su, Baihai Huang, Songmin Xu, Huan He, Cijiang Liu, Fang |
| description | Abstract Aims To investigate the renal pathological implications in type 2 diabetes mellitus patients with renal involvement. Methods A total of 328 type 2 diabetes mellitus (T2DM) patients with renal involvement who underwent a renal biopsy and received follow-up for at least one year were recruited in our study. The patients were divided into the diabetic nephropathy (DN), non-diabetic renal disease (NDRD), and NDRD superimposed on DN groups based on the pathological diagnosis. Renal outcomes were defined by the initiation of renal replacement therapy or doubling of the serum creatinine. Kaplan–Meier analysis was used to compare renal survival, and Cox proportional hazard analysis was used to determine the predictors of renal outcomes in the DN group. Results Renal biopsy findings revealed that 188 patients (57.32%) had pure DN, 121 patients (36.89%) had NDRD alone, and 19 patients (5.79%) had NDRD superimposed on DN. The most frequent subclassification of NDRD was membranous nephropathy (MN). Compared with the NDRD and NDRD superimposed on DN groups, patients with pure DN had poorer renal function and lower renal survival rates. In the DN group, the five-year renal survival rates of glomerular classes of I, IIa, IIb, III and IV were 100%, 84.62%, 60%, 47.5% and 33.33%, respectively. Multivariate Cox proportional hazard analysis showed that the glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes, while interstitial fibrosis/inflammation and arteriolar hyalinosis were not independently associated with renal outcomes in the DN group. Conclusions Making an accurate pathologic diagnosis by renal biopsy is crucial for diabetes mellitus (DM) patients with renal involvement. The findings of our present study indicated that patients with pure DN had poorer renal outcomes than patients with NDRD or NDRD superimposed on DN. The classification of glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes in the DN group. More studies with large samples and longer time follow-up are needed to evaluate the relationship between pathological changes and clinical characteristics in T2DM patients who have renal involvement. |
| doi_str_mv | 10.1016/j.jdiacomp.2016.10.024 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1859489405</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1056872716303348</els_id><sourcerecordid>4318072801</sourcerecordid><originalsourceid>FETCH-LOGICAL-c484t-214549f76c4a4850f9d8532fbc5fc7e686f9c8590d6c4c9ecc89e74caf2925f63</originalsourceid><addsrcrecordid>eNqNkltr1UAQxxdRbK1-hRLwxZcc957NiyilXqAgVAXBhyVnM2s3JtmY3Rw5396Jpxfoi33ameE3MzvzH0JOGd0wyvTrbtO1oXFxmDYcfQxuKJePyDEzlSilpt8fo02VLk3FqyPyLKWOUqqVYk_JEa-MMIzSY_LjEsamL6YmX8U-_gwOnTBMPRo5xDEVYSzyfoKCF9hvCxlSMUDfh7ykNSvAmFPxJ-SrYv5XKYy72O9gwPhz8sQ3fYIX1-8J-fb-_OvZx_Li84dPZ-8uSieNzCVnUsnaV9rJRhpFfd0aJbjfOuVdBdpoXzujatoi4WpwztRQSdd4XnPltTghrw51pzn-XiBlO4Tk8JPNCHFJlmGyNLWk6gGoqBnDNXFEX95Du7jMOOJKVUIbY3SFlD5Qbo4pzeDtNIehmfeWUbsqZTt7o5RdlVrjqBQmnl6XX7YDtLdpN9Ig8PYAAK5uF2C2yeG2HbRhBpdtG8P_e7y5V8L1YVw1_gV7SHfz2MQttV_We1nPhWlBhZBG_AXUX7zn</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1873688867</pqid></control><display><type>article</type><title>Renal pathological implications in type 2 diabetes mellitus patients with renal involvement</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Li, Li ; Zhang, Xiuhui ; Li, Zhicheng ; Zhang, Rui ; Guo, Ruikun ; Yin, Qinghua ; Yang, Lichuan ; Yue, Rongzheng ; Su, Baihai ; Huang, Songmin ; Xu, Huan ; He, Cijiang ; Liu, Fang</creator><creatorcontrib>Li, Li ; Zhang, Xiuhui ; Li, Zhicheng ; Zhang, Rui ; Guo, Ruikun ; Yin, Qinghua ; Yang, Lichuan ; Yue, Rongzheng ; Su, Baihai ; Huang, Songmin ; Xu, Huan ; He, Cijiang ; Liu, Fang</creatorcontrib><description>Abstract Aims To investigate the renal pathological implications in type 2 diabetes mellitus patients with renal involvement. Methods A total of 328 type 2 diabetes mellitus (T2DM) patients with renal involvement who underwent a renal biopsy and received follow-up for at least one year were recruited in our study. The patients were divided into the diabetic nephropathy (DN), non-diabetic renal disease (NDRD), and NDRD superimposed on DN groups based on the pathological diagnosis. Renal outcomes were defined by the initiation of renal replacement therapy or doubling of the serum creatinine. Kaplan–Meier analysis was used to compare renal survival, and Cox proportional hazard analysis was used to determine the predictors of renal outcomes in the DN group. Results Renal biopsy findings revealed that 188 patients (57.32%) had pure DN, 121 patients (36.89%) had NDRD alone, and 19 patients (5.79%) had NDRD superimposed on DN. The most frequent subclassification of NDRD was membranous nephropathy (MN). Compared with the NDRD and NDRD superimposed on DN groups, patients with pure DN had poorer renal function and lower renal survival rates. In the DN group, the five-year renal survival rates of glomerular classes of I, IIa, IIb, III and IV were 100%, 84.62%, 60%, 47.5% and 33.33%, respectively. Multivariate Cox proportional hazard analysis showed that the glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes, while interstitial fibrosis/inflammation and arteriolar hyalinosis were not independently associated with renal outcomes in the DN group. Conclusions Making an accurate pathologic diagnosis by renal biopsy is crucial for diabetes mellitus (DM) patients with renal involvement. The findings of our present study indicated that patients with pure DN had poorer renal outcomes than patients with NDRD or NDRD superimposed on DN. The classification of glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes in the DN group. More studies with large samples and longer time follow-up are needed to evaluate the relationship between pathological changes and clinical characteristics in T2DM patients who have renal involvement.</description><identifier>ISSN: 1056-8727</identifier><identifier>EISSN: 1873-460X</identifier><identifier>DOI: 10.1016/j.jdiacomp.2016.10.024</identifier><identifier>PMID: 27838100</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Biopsy ; Body mass index ; Classification ; Clinical features ; Diabetes ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - epidemiology ; Diabetes Mellitus, Type 2 - pathology ; Diabetes Mellitus, Type 2 - physiopathology ; Diabetic Nephropathies - epidemiology ; Diabetic Nephropathies - pathology ; Diabetic Nephropathies - physiopathology ; Diabetic nephropathy ; Diabetic retinopathy ; Endocrinology & Metabolism ; Female ; Humans ; Inflammation ; Kidney - pathology ; Kidney - physiopathology ; Kidney diseases ; Kidney Function Tests ; Male ; Medical prognosis ; Microscopy ; Middle Aged ; Multivariate analysis ; Non diabetic renal disease ; Pathology ; Renal biopsy ; Renal Insufficiency, Chronic - complications ; Renal Insufficiency, Chronic - epidemiology ; Renal Insufficiency, Chronic - pathology ; Renal Insufficiency, Chronic - physiopathology ; Renal outcomes ; Retrospective Studies ; Risk Factors ; Statistical analysis</subject><ispartof>Journal of diabetes and its complications, 2017-01, Vol.31 (1), p.114-121</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jan 01, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c484t-214549f76c4a4850f9d8532fbc5fc7e686f9c8590d6c4c9ecc89e74caf2925f63</citedby><cites>FETCH-LOGICAL-c484t-214549f76c4a4850f9d8532fbc5fc7e686f9c8590d6c4c9ecc89e74caf2925f63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1056872716303348$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27838100$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Li</creatorcontrib><creatorcontrib>Zhang, Xiuhui</creatorcontrib><creatorcontrib>Li, Zhicheng</creatorcontrib><creatorcontrib>Zhang, Rui</creatorcontrib><creatorcontrib>Guo, Ruikun</creatorcontrib><creatorcontrib>Yin, Qinghua</creatorcontrib><creatorcontrib>Yang, Lichuan</creatorcontrib><creatorcontrib>Yue, Rongzheng</creatorcontrib><creatorcontrib>Su, Baihai</creatorcontrib><creatorcontrib>Huang, Songmin</creatorcontrib><creatorcontrib>Xu, Huan</creatorcontrib><creatorcontrib>He, Cijiang</creatorcontrib><creatorcontrib>Liu, Fang</creatorcontrib><title>Renal pathological implications in type 2 diabetes mellitus patients with renal involvement</title><title>Journal of diabetes and its complications</title><addtitle>J Diabetes Complications</addtitle><description>Abstract Aims To investigate the renal pathological implications in type 2 diabetes mellitus patients with renal involvement. Methods A total of 328 type 2 diabetes mellitus (T2DM) patients with renal involvement who underwent a renal biopsy and received follow-up for at least one year were recruited in our study. The patients were divided into the diabetic nephropathy (DN), non-diabetic renal disease (NDRD), and NDRD superimposed on DN groups based on the pathological diagnosis. Renal outcomes were defined by the initiation of renal replacement therapy or doubling of the serum creatinine. Kaplan–Meier analysis was used to compare renal survival, and Cox proportional hazard analysis was used to determine the predictors of renal outcomes in the DN group. Results Renal biopsy findings revealed that 188 patients (57.32%) had pure DN, 121 patients (36.89%) had NDRD alone, and 19 patients (5.79%) had NDRD superimposed on DN. The most frequent subclassification of NDRD was membranous nephropathy (MN). Compared with the NDRD and NDRD superimposed on DN groups, patients with pure DN had poorer renal function and lower renal survival rates. In the DN group, the five-year renal survival rates of glomerular classes of I, IIa, IIb, III and IV were 100%, 84.62%, 60%, 47.5% and 33.33%, respectively. Multivariate Cox proportional hazard analysis showed that the glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes, while interstitial fibrosis/inflammation and arteriolar hyalinosis were not independently associated with renal outcomes in the DN group. Conclusions Making an accurate pathologic diagnosis by renal biopsy is crucial for diabetes mellitus (DM) patients with renal involvement. The findings of our present study indicated that patients with pure DN had poorer renal outcomes than patients with NDRD or NDRD superimposed on DN. The classification of glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes in the DN group. More studies with large samples and longer time follow-up are needed to evaluate the relationship between pathological changes and clinical characteristics in T2DM patients who have renal involvement.</description><subject>Adult</subject><subject>Aged</subject><subject>Biopsy</subject><subject>Body mass index</subject><subject>Classification</subject><subject>Clinical features</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Diabetes Mellitus, Type 2 - pathology</subject><subject>Diabetes Mellitus, Type 2 - physiopathology</subject><subject>Diabetic Nephropathies - epidemiology</subject><subject>Diabetic Nephropathies - pathology</subject><subject>Diabetic Nephropathies - physiopathology</subject><subject>Diabetic nephropathy</subject><subject>Diabetic retinopathy</subject><subject>Endocrinology & Metabolism</subject><subject>Female</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Kidney - pathology</subject><subject>Kidney - physiopathology</subject><subject>Kidney diseases</subject><subject>Kidney Function Tests</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Microscopy</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Non diabetic renal disease</subject><subject>Pathology</subject><subject>Renal biopsy</subject><subject>Renal Insufficiency, Chronic - complications</subject><subject>Renal Insufficiency, Chronic - epidemiology</subject><subject>Renal Insufficiency, Chronic - pathology</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>Renal outcomes</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Statistical analysis</subject><issn>1056-8727</issn><issn>1873-460X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkltr1UAQxxdRbK1-hRLwxZcc957NiyilXqAgVAXBhyVnM2s3JtmY3Rw5396Jpxfoi33ameE3MzvzH0JOGd0wyvTrbtO1oXFxmDYcfQxuKJePyDEzlSilpt8fo02VLk3FqyPyLKWOUqqVYk_JEa-MMIzSY_LjEsamL6YmX8U-_gwOnTBMPRo5xDEVYSzyfoKCF9hvCxlSMUDfh7ykNSvAmFPxJ-SrYv5XKYy72O9gwPhz8sQ3fYIX1-8J-fb-_OvZx_Li84dPZ-8uSieNzCVnUsnaV9rJRhpFfd0aJbjfOuVdBdpoXzujatoi4WpwztRQSdd4XnPltTghrw51pzn-XiBlO4Tk8JPNCHFJlmGyNLWk6gGoqBnDNXFEX95Du7jMOOJKVUIbY3SFlD5Qbo4pzeDtNIehmfeWUbsqZTt7o5RdlVrjqBQmnl6XX7YDtLdpN9Ig8PYAAK5uF2C2yeG2HbRhBpdtG8P_e7y5V8L1YVw1_gV7SHfz2MQttV_We1nPhWlBhZBG_AXUX7zn</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Li, Li</creator><creator>Zhang, Xiuhui</creator><creator>Li, Zhicheng</creator><creator>Zhang, Rui</creator><creator>Guo, Ruikun</creator><creator>Yin, Qinghua</creator><creator>Yang, Lichuan</creator><creator>Yue, Rongzheng</creator><creator>Su, Baihai</creator><creator>Huang, Songmin</creator><creator>Xu, Huan</creator><creator>He, Cijiang</creator><creator>Liu, Fang</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>7T5</scope><scope>H94</scope></search><sort><creationdate>20170101</creationdate><title>Renal pathological implications in type 2 diabetes mellitus patients with renal involvement</title><author>Li, Li ; Zhang, Xiuhui ; Li, Zhicheng ; Zhang, Rui ; Guo, Ruikun ; Yin, Qinghua ; Yang, Lichuan ; Yue, Rongzheng ; Su, Baihai ; Huang, Songmin ; Xu, Huan ; He, Cijiang ; Liu, Fang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c484t-214549f76c4a4850f9d8532fbc5fc7e686f9c8590d6c4c9ecc89e74caf2925f63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biopsy</topic><topic>Body mass index</topic><topic>Classification</topic><topic>Clinical features</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Diabetes Mellitus, Type 2 - pathology</topic><topic>Diabetes Mellitus, Type 2 - physiopathology</topic><topic>Diabetic Nephropathies - epidemiology</topic><topic>Diabetic Nephropathies - pathology</topic><topic>Diabetic Nephropathies - physiopathology</topic><topic>Diabetic nephropathy</topic><topic>Diabetic retinopathy</topic><topic>Endocrinology & Metabolism</topic><topic>Female</topic><topic>Humans</topic><topic>Inflammation</topic><topic>Kidney - pathology</topic><topic>Kidney - physiopathology</topic><topic>Kidney diseases</topic><topic>Kidney Function Tests</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Microscopy</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Non diabetic renal disease</topic><topic>Pathology</topic><topic>Renal biopsy</topic><topic>Renal Insufficiency, Chronic - complications</topic><topic>Renal Insufficiency, Chronic - epidemiology</topic><topic>Renal Insufficiency, Chronic - pathology</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><topic>Renal outcomes</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Statistical analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Li</creatorcontrib><creatorcontrib>Zhang, Xiuhui</creatorcontrib><creatorcontrib>Li, Zhicheng</creatorcontrib><creatorcontrib>Zhang, Rui</creatorcontrib><creatorcontrib>Guo, Ruikun</creatorcontrib><creatorcontrib>Yin, Qinghua</creatorcontrib><creatorcontrib>Yang, Lichuan</creatorcontrib><creatorcontrib>Yue, Rongzheng</creatorcontrib><creatorcontrib>Su, Baihai</creatorcontrib><creatorcontrib>Huang, Songmin</creatorcontrib><creatorcontrib>Xu, Huan</creatorcontrib><creatorcontrib>He, Cijiang</creatorcontrib><creatorcontrib>Liu, Fang</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Journal of diabetes and its complications</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Li</au><au>Zhang, Xiuhui</au><au>Li, Zhicheng</au><au>Zhang, Rui</au><au>Guo, Ruikun</au><au>Yin, Qinghua</au><au>Yang, Lichuan</au><au>Yue, Rongzheng</au><au>Su, Baihai</au><au>Huang, Songmin</au><au>Xu, Huan</au><au>He, Cijiang</au><au>Liu, Fang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Renal pathological implications in type 2 diabetes mellitus patients with renal involvement</atitle><jtitle>Journal of diabetes and its complications</jtitle><addtitle>J Diabetes Complications</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>31</volume><issue>1</issue><spage>114</spage><epage>121</epage><pages>114-121</pages><issn>1056-8727</issn><eissn>1873-460X</eissn><abstract>Abstract Aims To investigate the renal pathological implications in type 2 diabetes mellitus patients with renal involvement. Methods A total of 328 type 2 diabetes mellitus (T2DM) patients with renal involvement who underwent a renal biopsy and received follow-up for at least one year were recruited in our study. The patients were divided into the diabetic nephropathy (DN), non-diabetic renal disease (NDRD), and NDRD superimposed on DN groups based on the pathological diagnosis. Renal outcomes were defined by the initiation of renal replacement therapy or doubling of the serum creatinine. Kaplan–Meier analysis was used to compare renal survival, and Cox proportional hazard analysis was used to determine the predictors of renal outcomes in the DN group. Results Renal biopsy findings revealed that 188 patients (57.32%) had pure DN, 121 patients (36.89%) had NDRD alone, and 19 patients (5.79%) had NDRD superimposed on DN. The most frequent subclassification of NDRD was membranous nephropathy (MN). Compared with the NDRD and NDRD superimposed on DN groups, patients with pure DN had poorer renal function and lower renal survival rates. In the DN group, the five-year renal survival rates of glomerular classes of I, IIa, IIb, III and IV were 100%, 84.62%, 60%, 47.5% and 33.33%, respectively. Multivariate Cox proportional hazard analysis showed that the glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes, while interstitial fibrosis/inflammation and arteriolar hyalinosis were not independently associated with renal outcomes in the DN group. Conclusions Making an accurate pathologic diagnosis by renal biopsy is crucial for diabetes mellitus (DM) patients with renal involvement. The findings of our present study indicated that patients with pure DN had poorer renal outcomes than patients with NDRD or NDRD superimposed on DN. The classification of glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes in the DN group. More studies with large samples and longer time follow-up are needed to evaluate the relationship between pathological changes and clinical characteristics in T2DM patients who have renal involvement.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27838100</pmid><doi>10.1016/j.jdiacomp.2016.10.024</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Aged Biopsy Body mass index Classification Clinical features Diabetes Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - pathology Diabetes Mellitus, Type 2 - physiopathology Diabetic Nephropathies - epidemiology Diabetic Nephropathies - pathology Diabetic Nephropathies - physiopathology Diabetic nephropathy Diabetic retinopathy Endocrinology & Metabolism Female Humans Inflammation Kidney - pathology Kidney - physiopathology Kidney diseases Kidney Function Tests Male Medical prognosis Microscopy Middle Aged Multivariate analysis Non diabetic renal disease Pathology Renal biopsy Renal Insufficiency, Chronic - complications Renal Insufficiency, Chronic - epidemiology Renal Insufficiency, Chronic - pathology Renal Insufficiency, Chronic - physiopathology Renal outcomes Retrospective Studies Risk Factors Statistical analysis |
| title | Renal pathological implications in type 2 diabetes mellitus patients with renal involvement |
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