PMID- 36517108
OWN - NLM
STAT- MEDLINE
DCOM- 20221216
LR  - 20221222
IS  - 2052-4897 (Electronic)
IS  - 2052-4897 (Linking)
VI  - 10
IP  - 6
DP  - 2022 Dec
TI  - Prevalence of non-diabetic kidney disease and inability of clinical predictors to 
      differentiate it from diabetic kidney disease: results from a prospectively 
      performed renal biopsy study.
LID - 10.1136/bmjdrc-2022-003058 [doi]
LID - e003058
AB  - INTRODUCTION: Renal involvement in type 2 diabetes mellitus (T2DM) may be due to 
      diabetes (diabetic kidney disease (DKD)), causes other than diabetes 
      (non-diabetic kidney disease (NDKD)) or overlap of DKD and NDKD (mixed kidney 
      disease group). Prevalence of NDKD and predictive value of clinical or 
      biochemical indicators have been explored in retrospective cohorts with 
      preselection biases warranting the need for prospectively conducted unbiased 
      renal biopsy study. RESEARCH DESIGN AND METHODS: Consecutive subjects aged >18 
      years with T2DM and renal involvement with estimated glomerular filtration rate 
      of 30-60 mL/min/m(2) and/or albumin:creatinine ratio of >300 mg/g were offered 
      renal biopsy. Prevalence of DKD, NDKD and mixed kidney disease was documented. 
      Clinical/laboratory parameters of subjects were recorded and compared between 
      groups and were tested for ability to predict histopathological diagnosis. 
      RESULTS: We screened 6247 subjects with T2DM of which 869 fulfilled inclusion 
      criteria for biopsy. Of the 869 subjects, biopsy was feasible in 818 subjects. 
      Out of 818, we recruited first 110 subjects who agreed to undergo renal biopsy. 
      Among those 110 subjects, 73 (66.4%) had DKD; 20 (18.2 %) had NDKD; and 17 (15.4 
      %) had mixed kidney disease. Subjects with NDKD as compared with DKD had shorter 
      duration of diabetes (p<0.001), absence of retinopathy (p<0.001) and absence of 
      neuropathy (p<0.001). Logistic regression revealed that only presence of 
      retinopathy and duration of diabetes were statistically significant to predict 
      histopathological diagnosis of DKD. 30% of DKD did not have retinopathy, thereby 
      limiting the utility of the same as a discriminator. Use of traditional 
      indicators of biopsy would have indicated a need for renal biopsy in 87.2% of 
      subjects, though 64.5% of the subjects had DKD, who would not have benefitted 
      from biopsy. CONCLUSION: NDKD and mixed kidney disease in T2DM with renal 
      involvement are very common and traditionally used parameters to select biopsies 
      are of limited value in clinical decision making.
CI  - (c) Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Basu, Madhurima
AU  - Basu M
AUID- ORCID: 0000-0003-4693-5795
AD  - Endocrinology and Metabolism, Institute of Postgraduate Medical Education and 
      Research, Kolkata, India.
FAU - Pulai, Smartya
AU  - Pulai S
AD  - Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, 
      India.
FAU - Neogi, Subhasis
AU  - Neogi S
AD  - Endocrinology and Metabolism, Institute of Postgraduate Medical Education and 
      Research, Kolkata, India.
FAU - Banerjee, Mainak
AU  - Banerjee M
AD  - Endocrinology and Metabolism, Institute of Postgraduate Medical Education and 
      Research, Kolkata, India.
FAU - Bhattacharyya, Nitai P
AU  - Bhattacharyya NP
AD  - Endocrinology and Metabolism, Institute of Postgraduate Medical Education and 
      Research, Kolkata, India.
FAU - Sengupta, Sanghamitra
AU  - Sengupta S
AD  - Biochemistry, University of Calcutta, Kolkata, West Bengal, India.
FAU - Mukhopadhyay, Pradip
AU  - Mukhopadhyay P
AUID- ORCID: 0000-0002-4580-9589
AD  - Endocrinology and Metabolism, Institute of Postgraduate Medical Education and 
      Research, Kolkata, India.
FAU - Ray Chaudhury, Arpita
AU  - Ray Chaudhury A
AD  - Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, 
      India.
FAU - Ghosh, Sujoy
AU  - Ghosh S
AUID- ORCID: 0000-0001-5397-961X
AD  - Endocrinology and Metabolism, Institute of Postgraduate Medical Education and 
      Research, Kolkata, India drsujoyghosh2000@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - BMJ Open Diabetes Res Care
JT  - BMJ open diabetes research & care
JID - 101641391
SB  - IM
MH  - Humans
MH  - *Diabetes Mellitus, Type 2/complications/diagnosis/epidemiology
MH  - Prevalence
MH  - Retrospective Studies
MH  - *Diabetic Nephropathies/diagnosis/epidemiology/etiology
MH  - Biopsy/adverse effects
MH  - *Retinal Diseases/complications
PMC - PMC9756194
OTO - NOTNLM
OT  - Diabetes Mellitus, Type 2
OT  - Kidney Diseases
COIS- Competing interests: None declared.
EDAT- 2022/12/15 06:00
MHDA- 2022/12/17 06:00
PMCR- 2022/12/14
CRDT- 2022/12/14 20:53
PHST- 2022/07/27 00:00 [received]
PHST- 2022/11/22 00:00 [accepted]
PHST- 2022/12/14 20:53 [entrez]
PHST- 2022/12/15 06:00 [pubmed]
PHST- 2022/12/17 06:00 [medline]
PHST- 2022/12/14 00:00 [pmc-release]
AID - 10/6/e003058 [pii]
AID - bmjdrc-2022-003058 [pii]
AID - 10.1136/bmjdrc-2022-003058 [doi]
PST - ppublish
SO  - BMJ Open Diabetes Res Care. 2022 Dec;10(6):e003058. doi: 
      10.1136/bmjdrc-2022-003058.