#6467 determinants of non-diabetic kidney diseases in diabetic patients

Abstract Background and Aims While diabetic nephropathy is the main kidney disease in patients with type 2 diabetes mellitus, a variety of non-diabetic kidney diseases (NDKD) may also occur. The decision to order a biopsy in diabetic patients is not an easy one as diabetic kidney disease is itself a proteinuric condition. The main objective of this study is to define factors that may differentiate isolated diabetic nephropathy and non-diabetic kidney disease in diabetic patients. In addition, we also aimed to analyze the effects of treatment choices on renal and overall survival. Method The study was conducted at a university hospital, which served as a tertiary healthcare center. One hundred and three diabetic patients who underwent kidney biopsy were involved in the study. Demographic characteristics, physical examination findings, laboratory tests and kidney biopsy findings were retrospectively evaluated. Results According to kidney biopsy findings 30 patients (29,1%) had isolated diabetic nephropathy. NDKDs were present in 73 (70,9%) of the patients. 78,1% of the patients with NDKDs had non-diabetic glomerular diseases. Among glomerular diseases, focal segmental glomerulosclerosis (36,9%), IgA nephropathy (17,8%) and membranous nephropathy (13,7%) were the leading three diseases. The duration of diabetes (p=0,00), HBA1C level (p=0,00) and the amount of proteinuria (p=0,02) were higher in patients who had isolated diabetic nephropathy. Presence of diabetic retinopathy (p=0,00), concomitant vascular diseases (p=0,02) and the use of insulin treatment were also more often in patients with isolated diabetic nephropathy. Multivariate analysis revealed that patients with higher HBA1C levels and longer diabetes duration had more tendencies to have isolated diabetic nephropathy. Immunosuppressive treatments for glomerular diseases were administered in around 50% of the patients. However, renal and overall survivals were not different between patients who received immunosuppressive treatments and those who didn't. Conclusion A renal biopsy in diabetic patients might be preserved for those with shorter diabetes duration and lower HBA1C levels. As poor glycemic control and susceptibility to infections pose additional risks, immunosuppressive treatments might not always be beneficial.