TY - JOUR
T1 - Histopathologic and Clinical Features in Patients with Diabetes and Kidney Disease
AU - Sanghavi, Sarah F.
AU - Roark, Travis
AU - Zelnick, Leila R.
AU - Najafian, Behzad
AU - Andeen, Nicole K.
AU - Alpers, Charles E.
AU - Pichler, Raimund
AU - Ayers, Ernest
AU - De Boer, Ian H.
N1 - Publisher Copyright:
© 2020 by the American Society of Nephrology.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Background The discovery of nondiabetic kidney disease (NDKD) in an individual patient with diabetes may have significant treatment implications. Extensive histopathologic data in this population are lacking, but they may provide insights into the complex pathogenesis of diabetic nephropathy (DN) and reveal specific phenotypes for the development of targeted therapies. This study seeks to elucidate the clinical and laboratory parameters associated with the spectrum of kidney histopathologic features in patients with diabetes. Methods This study is a retrospective analysis of 399 kidney biopsies assessed from 2014 to 2016 at the University of Washington among patients with diabetes. More comprehensive clinical data were evaluated in a subset of 79 participants. Results Of the 399 biopsies reviewed, 192 (48%) had a primary diagnosis of DN (including 26 with an additional diagnosis), and 207 (52%) had a primary diagnosis of NDKD (including 67 who also had DN). Retinopathy (sensitivity: 0.86; specificity: 0.81; OR, 27.1; 95% CI, 6.8 to 107.7) and higher levels of proteinuria (7.6 versus 4.1 g/d; P0.004) were associated with DN, whereas a physician description of AKI was associated with a lower risk of DN (OR, 0.13; 95% CI, 0.04 to 0.38). The four most prevalent diagnoses in participants with NDKD were FSGS in 39, nephrosclerosis in 29, IgA nephropathy in 27, and acute tubular injury in 21. Conclusions Among patients with diabetes who undergo kidney biopsy in the Pacific Northwest, approximately half have DN, and half have NDKD. Retinopathy and more severe proteinuria were associated with DN, and AKI was a more common descriptor in NDKD. Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_11_25_KID0003962020.mp3
AB - Background The discovery of nondiabetic kidney disease (NDKD) in an individual patient with diabetes may have significant treatment implications. Extensive histopathologic data in this population are lacking, but they may provide insights into the complex pathogenesis of diabetic nephropathy (DN) and reveal specific phenotypes for the development of targeted therapies. This study seeks to elucidate the clinical and laboratory parameters associated with the spectrum of kidney histopathologic features in patients with diabetes. Methods This study is a retrospective analysis of 399 kidney biopsies assessed from 2014 to 2016 at the University of Washington among patients with diabetes. More comprehensive clinical data were evaluated in a subset of 79 participants. Results Of the 399 biopsies reviewed, 192 (48%) had a primary diagnosis of DN (including 26 with an additional diagnosis), and 207 (52%) had a primary diagnosis of NDKD (including 67 who also had DN). Retinopathy (sensitivity: 0.86; specificity: 0.81; OR, 27.1; 95% CI, 6.8 to 107.7) and higher levels of proteinuria (7.6 versus 4.1 g/d; P0.004) were associated with DN, whereas a physician description of AKI was associated with a lower risk of DN (OR, 0.13; 95% CI, 0.04 to 0.38). The four most prevalent diagnoses in participants with NDKD were FSGS in 39, nephrosclerosis in 29, IgA nephropathy in 27, and acute tubular injury in 21. Conclusions Among patients with diabetes who undergo kidney biopsy in the Pacific Northwest, approximately half have DN, and half have NDKD. Retinopathy and more severe proteinuria were associated with DN, and AKI was a more common descriptor in NDKD. Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_11_25_KID0003962020.mp3
KW - diabetes and the kidney
KW - diabetes mellitus
KW - diabetic kidney disease
KW - diabetic retinopathy
KW - focal segmental glomerulosclerosis
KW - histopathology
KW - proteinuria
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U2 - 10.34067/KID.0003962020
DO - 10.34067/KID.0003962020
M3 - Article
AN - SCOPUS:85114064878
SN - 2641-7650
VL - 1
SP - 1217
EP - 1225
JO - Kidney360
JF - Kidney360
IS - 11
ER -