JBM  Vol.7 No.12 , December 2019
Non-Diabetic Renal Disease in Patients with Type 2 Diabetes Mellitus with Proteinuria
Abstract: Background: Diabetes mellitus (DM) is the leading cause of end stage renal disease (ESRD) worldwide. Although DM with proteinuria is the ultimate result of diabetic nephropathy (DN), a wide spectrum of non-diabetic renal diseases (NDRD) can occur in such patients. Objective: To observe the frequency and histological pattern of NDRD in diabetic patients with proteinuria and to explore their association with clinical and laboratory parameters. Methods: This cross-sectional study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2016 to September 2017. In this study a total of 38 cases of DM with proteinuria (>1 gm/24-hour) were selected purposively. Renal biopsy was done in all patients. Based on histological findings they were categorized into two groups; Group 1 with NDRD and Group II with DN. Their clinical and laboratory parameters were analyzed and compared. Results: Among the total study subjects, 21 (55.3%) were male and 17 (44.7%) were female, mean (±SD) age 43.45 ± 9.99 years in the NDRD group and 41.57 ± 9.50 years in the DN group. Thirty one cases (81.6%) out of thirty eight had NDRD and seven (18.4%) cases had isolated DN; therefore more than two third cases had NDRD. Duration of DM was found to be significantly shorter (p = 0.004) in the NDRD group. Diabetic retinopathy was present in 12.9% cases in NDRD group vs. 57.1% cases in DN group (p = 0.025). Frequency of microscopic hematuria was significantly higher (90.3%) in NDRD patients (p = 0.002). Conclusion: The frequency of NDRD in type 2 diabetic patients other than diabetic nephropathy is relatively high. Membrano proliferative glomeru-lonephritis and membranous nephropathy are more common in NDRD. Absence of diabetic retinopathy, presence of hematuria and shorter duration of DM are markers associated with NDRD in type 2 DM, which are important indicators for renal biopsy in diabetic patients with proteinuria.
Cite this paper: Mondal, M. , Hossain, R. , Hadiuzzaman, K. , Faroque, M. , Hossain, S. , Rahman, A. , Ashrafee, F. , Sarker, P. , Salahuddin, A. and Ahsan, M. (2019) Non-Diabetic Renal Disease in Patients with Type 2 Diabetes Mellitus with Proteinuria. Journal of Biosciences and Medicines, 7, 68-78. doi: 10.4236/jbm.2019.712007.

[1]   Zhou, J., Chen, X., Xie, Y., Li, J., Yamanaka, N. and Tong, X. (2007) A Differential Diagnostic Model of Diabetic Nephropathy and Non-Diabetic Renal Diseases. Nephrology Dialysis Transplantation, 23, 1940-1945.

[2]   National Institutes of Health (2010) US Renal Data Systems: USRDS 2010 Annual Data Report: Atlas of End Stage Renal Disease in the United States.

[3]   Gross, J.L., de Azevedo, M.J., Silveiro, S.P. and Canani, L.H. (2005) Diabetic Nephropathy: Diagnosis, Prevention, and Treatment. Diabetes Care, 28, 64-76.

[4]   Mogensen, C.E. and Christensen, C.K. (1984) Predicting Diabetic Nephropathy in Insulin-Dependent Patients. New England Journal of Medicine, 311, 89-93.

[5]   Andersen, A.R., Christiansen, J.S., Andersen, J.K., Kreiner, S. and Deckert, T. (1983) Diabetic Nephropathy in Type 1 (Insulin-Dependent) Diabetes: An Epidemiological Study. Diabetologia, 25, 496-501.

[6]   He, F., Xia, X., Wu, X.F., Yu, X.Q. and Huang, F.X. (2013) Diabetic Retinopathy in Predicting Diabetic Nephropathy in Patients with Type 2 Diabetes and Renal Disease: A Meta-Analysis. Diabetologia, 3, 457-466.

[7]   Prakash, J., Lodha, M., Singh, S.K., Vohra, R. and Raja, R. (2007) Diabetic Retinopathy Is a Poor Predictor of Type of Nephropathy in Proteinuric Type 2 Diabetic Patients. The Journal of the Association of Physicians of India, 55, 412-416.

[8]   Korbet, S.M. (2002) Percutaneous Renal Biopsy. Seminars in Nephrology, 22, 254-267.

[9]   Soni, S.S., Gowrishankar, S., Kishan, A.G. and Raman, A. (2006) Non Diabetic Renal Disease in Type 2 Diabetes Mellitus. Nephrology, 11, 533-537.

[10]   Mak, S.K., Gwi, E., Chan, K.W., Wong, P.N., Lo, K.Y., Lee, K.F. and Wong, A.K. (1997) Clinical Predictors of Non-Diabetic Renal Disease in Patients with Non-Insulin Dependent Diabetes Mellitus. Nephrology, Dialysis, Transplantation, 12, 2588-2591.

[11]   Ghani, A.A., Al Waheeb, S., Al Sahow, A. and Hussain, N. (2009) Renal Biopsy in Patients with Type 2 Diabetes Mellitus: Indications and Nature of the Lesions. Annals of Saudi Medicine, 29, 450-453.

[12]   Prakash, J. (2013) Non-Diabetic Renal Disease (NDRD) in Patients with Type 2 Diabetes Mellitus (Type 2 DM). Journal of the Association of Physicians of India, 61, 194-199.

[13]   Chang, T.I., Park, J.T., Kim, J.K., Kim, S.J., Oh, H.J., Yoo, D.E., Han, S.H., Yoo, T.H. and Kang, S.W. (2011) Renal Outcomes in Patients with Type 2 Diabetes with or without Coexisting Non-Diabetic Renal Disease. Diabetes Research and Clinical Practice, 92, 198-204.

[14]   John, G.T., Date, A., Korula, A., Jeyaseelan, L., Shastry, J.C. and Jacob, C.K. (1994) Nondiabetic Renal Disease in Noninsulin-Dependent Diabetics in a South Indian Hospital. Nephron, 67, 441-443.

[15]   Valmadrid, C.T., Klein, R., Moss, S.E. and Klein, B.E. (2000) The Risk of Cardiovascular Disease Mortality Associated with Microalbuminuria and Gross Proteinuria in Persons with Older-Onset Diabetes Mellitus. Archives of Internal Medicine, 160, 1093-1100.

[16]   Prakash, J., Gupta, T., Prakash, S. and Bhushan, P. (2015) Non-Diabetic Renal Disease in Type 2 Diabetes Mellitus: Study of Renal-Retinal Relationship. Indian Journal of Nephrology, 25, 222.

[17]   Das, U., Dakshinamurty, K.V., Prayaga, A. and Uppin, M.S. (2012) Nondiabetic Kidney Disease in Type 2 Diabetic Patients: A Single Center Experience. Indian Journal of Nephrology, 22, 358.

[18]   Pham, T.T., Sim, J.J., Kujubu, D.A., Liu, I.L. and Kumar, V.A. (2007) Prevalence of Nondiabetic Renal Disease in Diabetic Patients. American Journal of Nephrology, 27, 322-328.

[19]   Li, H., Li, X.W., Huang, Q.Y., Ye, W.L., Duan, L. and Li, Y. (2003) Non-Diabetic Renal Disease in Type II Diabetes Mellitus. Acta Academiae Medicinae Sinicae, 25, 101-104.

[20]   Beck, M.J., Evans, B.J., Quarry-Horn, J.L. and Kerrigan, J.R. (2002) Type 2 Diabetes Mellitus: Issues for the Medical Care of Pediatric and Adult Patients (Featured CME Topic: Pediatrics). Southern Medical Journal, 95, 992-1001.

[21]   Chawarnkul, O., Vareesangthip, K., Ongajyooth, L., Cheunsuchon, B. and Parichatikanond, P. (2009) Non-Diabetic Glomerular Disease in Type II DM: 10 Years Experience. Journal of the Medical Association of Thailand, 92, S57-S60.

[22]   Wilfred, D.C., Mysorekar, V.V., Venkataramana, R.S., Eshwarappa, M. and Subramanyan, R. (2013) Nondiabetic Renal Disease in Type 2 Diabetes Mellitus Patients: A Clinicopathological Study. Journal of Laboratory Physicians, 5, 94.

[23]   Wong, T.Y., Choi, P.C., Szeto, C.C., To, K.F., Tang, N.L., Chan, A.W., Li, P.K. and Lai, F.M. (2002) Renal Outcome in Type 2 Diabetic Patients with or without Coexisting Nondiabetic Nephropathies. Diabetes Care, 25, 900-905.

[24]   Tone, A., Shikata, K., Matsuda, M., Usui, H., Okada, S., Ogawa, D., Wada, J. and Makino, H. (2005) Clinical Features of Non-Diabetic Renal Diseases in Patients with Type 2 Diabetes. Diabetes Research and Clinical Practice, 69, 237-242.

[25]   Huang, F., Yang, Q., Chen, L., Tang, S., Liu, W. and Yu, X. (2007) Renal Pathological Change in Patients with Type 2 Diabetes Is Not Always Diabetic Nephropathy: A Report of 52 Cases. Clinical Nephrology, 67, 293-297.

[26]   Byun, J.M., Lee, C.H., Lee, S.R., Moon, J.Y., Lee, S.H., Lee, T.W., Ihm, C.G. and Jeong, K.H. (2013) Renal Outcomes and Clinical Course of Nondiabetic Renal Diseases in Patients with Type 2 Diabetes. The Korean Journal of Internal Medicine, 28, 565-572.

[27]   Yaqub, S., Kashif, W. and Hussain, S.A. (2012) Non-Diabetic Renal Disease in Patients with Type-2 Diabetes Mellitus. Saudi Journal of Kidney Disease and Transplantation, 23, 1000-1007.