Diabetic nephropathy is the most common cause of chronic kidney disease and
the number afflicted patients continues to rise. The presence of proteinuria
has been considered as a prerequisite for the diagnosis of diabetic
nephropathy. But one third to one half of type 2 diabetics with CKD have no proteinuria and the pathology of non proteinuric CKD in this group remains unclear
as renal biopsy is commonly not performed in these patients. The present
study addresses the question: Can a classical diabetic nephropathy occur in the
absence of proteinuria? Method: We examined renal biopsies of subjects who
underwent nephrectomy from 1999 to 2009 for renal cancer, had eGFR < 60
ml/min and no microalbuminuria or proteinuria. 10 diabetics were matched with
10 non diabetics for age, hypertension and baseline creatinine. Results: The
diabetic subjects had advanced diabetic lesions even in absence of proteinuria.
Tubules and tubular-interstitium was relatively well preserved. Diabetic
glomerulosclerosis can occur in the absence of microalbuminuria. Conclusions:
It is becoming increasingly apparent that a considerable proportion of subjects
with type 2 diabetes can develop renal impairment in the absence of albuminuria. Diabetic glomerulosclerosis may develop before the proteinuria can be
detected and relying on albumin excretion as first sign for renal involvement
may be too late in diagnosing and modifying the progression of the kidney
Cite this paper
Budhiraja, P. , Thajudeen, B. and Popovtzer, M. (2013) Absence of albuminuria in type 2 diabetics with classical diabetic nephropathy: Clinical pathological study. Journal of Biomedical Science and Engineering, 6, 20-25. doi: 10.4236/jbise.2013.65A005.
 Williams, M.E. (2005) Diabetic nephropathy: The proteinuria hypothesis. American Journal of Nephrology, 25, 77-94. doi:10.1159/000084286
 ACE Inhibitors in Diabetic Nephropathy Trialist Group (2001) Should all patients with type 1 diabetes mellitus and microalbuminuria receive angiotensin converting enzyme inhibitors? A meta-analysis of individual patient data. Annals of Internal Medicine, 134, 370-379.
 American Diabetes Association Clinical Practice Guidelines (2004) Nephropathy in Diabetes. Diabetes Care, 27, S79-S83.
 (2007) KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. American Journal of Kidney Diseases, 49, S12-S154. doi:10.1053/j.ajkd.2006.12.005
 Retnakaran, R., Cull, C.A., Thorne, K.I., Adler, A.I., Holman, R.R. and UKPDS Study Group (2006) Risk factors for renal dysfunction in type 2 diabetes: UK prospective diabetes study 74. Diabetes, 55, 1832-1839.
 Kramer, H.J., Nguyen, Q.D., Curhan, G. and Hsu, C.Y. (2003) Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. JAMA, 289, 3273-3277.
 MacIsaac, R.J., Panagiotopoulos, S., McNeil, K.J., Smith, T.J., Tsalamandris, C., Hao, H., et al. (2006) Is nonalbuminuric renal insufficiency in type 2 diabetes related to an increase in intrarenal vascular disease? Diabetes Care, 29, 1560-1566. doi:10.2337/dc05-1788
 Kramer, C.K., Leitão, C.B., Pinto, L.C., Silveiro, S.P., Gross, J.L. and Canani, L.H. (2007) Clinical and laboratory profile of patients with type 2 diabetes with low glomerular filtration rate and normoalbuminuria. Diabetes Care, 30, 1998-2000. doi:10.2337/dc07-0387
 Caramori, M.L., Fioretto, P. and Mauer, M. (2003) Low glomerular filtration rate in normoalbuminuric type 1 diabetic patients: An indicator of more advanced glomerular lesions. Diabetes, 52, 1036-1040.
 Yagil, C., Barak, A., Ben-Dor, D., Rosenmann, E., Bernheim, J., Rosner, M., et al. (2005) Nonproteinuric diabetes-associated nephropathy in the Cohen rat model of type 2 diabetes. Diabetes, 54, 1487-1496.
 Tervaert, T.W., Mooyaart, A.L., Amann, K., Cohen, A.H., Cook, H.T., Drachenberg, C.B., et al. (2010) Renal pathology society. Pathologic classification of diabetic nephropathy. Journal of the American Society of Nephrology, 21, 556-563. doi:10.1681/ASN.2010010010
 Watanabe, Y., Fujii, H., Aoki, K., Kanazawa, Y. and Miyakawa, T. (2009) A cross-sectional survey of chronic kidney disease and diabetic kidney disease in Japanese type 2 diabetic patients at four urban diabetes clinics. Internal Medicine, 48, 411-414.
 Ziyadeh, F.N. and Wolf, G. (2008) Pathogenesis of the podocytopathy and proteinuria in diabetis glomerulopathy. Current Diabetes Reviews, 4, 39-45.
 Diez-Sampedro, A., Lenz, O. and Fornori, A. (2011) Podocytopathy in diabetes: A metabolic and endocrine disorder. American Journal of Kidney Diseases, 58, 637646. doi:10.1053/j.ajkd.2011.03.035
 Najafian, B., Alpers, C.E. and Fogo, A.B. (2011) Pathology of human diabetic nephropathy. Contributions to Nephrology, 170, 36-47. doi:10.1159/000324942
 Weil, E.J., Lemley, K.V., Yee, B., Lovato, T., Richardsom, M., Myers, B.D., et al. (2011) Podocyte detachment in type 2 diabetic nephropathy. American Journal of Nephrology, 33, 21-24. doi:10.1159/000327047