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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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-07-01
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| Series: | Indian Journal of Kidney Diseases |
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| Online Access: | https://journals.lww.com/10.4103/ijkd.ijkd_4_22 |
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| author | Isha Tiwari Arora Jay Arora Swarnalatha Guditi Raja Karthik Megha Uppin Sree Bhushan Raju Gangadhar Taduri |
| author_facet | Isha Tiwari Arora Jay Arora Swarnalatha Guditi Raja Karthik Megha Uppin Sree Bhushan Raju Gangadhar Taduri |
| author_sort | Isha Tiwari Arora |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-655a95c8ca45403eb13f060ff067e5e5 |
| institution | OA Journals |
| issn | 2950-0761 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | Wolters Kluwer Medknow Publications |
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| series | Indian Journal of Kidney Diseases |
| spelling | doaj-art-655a95c8ca45403eb13f060ff067e5e52025-08-20T02:30:28ZengWolters Kluwer Medknow PublicationsIndian Journal of Kidney Diseases2950-07612022-07-01132710.4103/ijkd.ijkd_4_22Clinical, Laboratory, and Histopathological Features of Nonproteinuric Diabetic Kidney Disease and Proteinuric Diabetic Kidney DiseaseIsha Tiwari AroraJay AroraSwarnalatha GuditiRaja KarthikMegha UppinSree Bhushan RajuGangadhar TaduriBackground: 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.https://journals.lww.com/10.4103/ijkd.ijkd_4_22arteriosclerosisischemic changesnonproteinuric diabetic kidney diseaseproteinuric diabetic kidney disease |
| spellingShingle | Isha Tiwari Arora Jay Arora Swarnalatha Guditi Raja Karthik Megha Uppin Sree Bhushan Raju Gangadhar Taduri Clinical, Laboratory, and Histopathological Features of Nonproteinuric Diabetic Kidney Disease and Proteinuric Diabetic Kidney Disease Indian Journal of Kidney Diseases arteriosclerosis ischemic changes nonproteinuric diabetic kidney disease proteinuric diabetic kidney disease |
| title | Clinical, Laboratory, and Histopathological Features of Nonproteinuric Diabetic Kidney Disease and Proteinuric Diabetic Kidney Disease |
| title_full | Clinical, Laboratory, and Histopathological Features of Nonproteinuric Diabetic Kidney Disease and Proteinuric Diabetic Kidney Disease |
| title_fullStr | Clinical, Laboratory, and Histopathological Features of Nonproteinuric Diabetic Kidney Disease and Proteinuric Diabetic Kidney Disease |
| title_full_unstemmed | Clinical, Laboratory, and Histopathological Features of Nonproteinuric Diabetic Kidney Disease and Proteinuric Diabetic Kidney Disease |
| title_short | Clinical, Laboratory, and Histopathological Features of Nonproteinuric Diabetic Kidney Disease and Proteinuric Diabetic Kidney Disease |
| title_sort | clinical laboratory and histopathological features of nonproteinuric diabetic kidney disease and proteinuric diabetic kidney disease |
| topic | arteriosclerosis ischemic changes nonproteinuric diabetic kidney disease proteinuric diabetic kidney disease |
| url | https://journals.lww.com/10.4103/ijkd.ijkd_4_22 |
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