Clinical, Laboratory, and Histopathological Features of Nonproteinuric Diabetic Kidney Disease and Proteinuric Diabetic Kidney Disease
Background: Screening diabetic patients for the development of kidney disease is of utmost importance in the prevention of diabetic kidney disease (DKD). Although worsening of albuminuria has been associated with the progression of DKD traditionally, it is now becoming apparent that DKD may progress...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2022-07-01
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| Series: | Indian Journal of Kidney Diseases |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/ijkd.ijkd_4_22 |
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| Summary: | Background:
Screening diabetic patients for the development of kidney disease is of utmost importance in the prevention of diabetic kidney disease (DKD). Although worsening of albuminuria has been associated with the progression of DKD traditionally, it is now becoming apparent that DKD may progress even in the absence of albuminuria. There is a paucity of studies on the prevalence and clinical profile of the patients with this “nonproteinuric” kidney disease in the Indian population. This study was undertaken to examine these features.
Methods:
A retrospective observational study was conducted at a single tertiary care center in South India. Type 2 diabetic patients with either serum creatinine >1.5 mg/dL and/or proteinuria>500 mg/dL (N = 249) were included in the study. Demographic data and data on clinical features, comorbidities, and laboratory parameters were collected. The histopathological profile of renal biopsies was recorded. Clinical and histopathological features of those with proteinuric DKD (P-DKD) and those without nonproteinuric DKD (NP-DKD) were compared.
Results:
Among 249 patients (mean age 53.4 ± 9.1 years; 22% females), NP-DKD was seen in 31.3%. Pedal edema (89.5% vs. 62%; P < 0.0001), facial puffiness (42.1% vs. 21.8%; P = 0.002), and duration of diabetes (110 ± 6.1 vs. 96.23 ± 5.52 months) were significantly higher in P-DKD, respectively, whereas the prevalence of hypertension was more in NP-DKD (87.7% vs. 75.6%). Vascular complications such as stroke (9.9% vs. 3.8%; P = 0.01) and diabetic retinopathy (62.5% vs. 35.9%; P ≤ 0.001) were significantly higher in P-DKD. Kimmelstiel–Wilson nodules (44.4% vs. 25.6%) and interstitial fibrosis/tubular atrophy (44.5% vs. 36.92%; P = 0.041) were significant in P-DKD. Arteriolar hyalinosis (83.7% vs. 69.1%) and arteriosclerosis (66.3% vs. 41.8%) was more common in NP-DKD.
Conclusions:
Distinctive clinical, laboratory, and histopathological characteristics establish the need for awareness of NP-DKD and P-DKD as separate entities. Therapeutic and prognostic implications of these disease entities demand attention by nephrologists. |
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| ISSN: | 2950-0761 |