Kidney biopsy can help to predict renal outcomes of patients with type 2 diabetes mellitus.

IF 2.9 3区医学 Q1 UROLOGY & NEPHROLOGY

Kidney Research and Clinical Practice Pub Date : 2025-01-01 Epub Date: 2024-01-12 DOI:10.23876/j.krcp.23.059

Wook-Joon Kim, Taehoon Oh, Nam Hun Heo, Kyungsup Kwon, Ga-Eun Shin, Se-Hwi Jeong, Ji Hye Lee, Samel Park, Nam-Jun Cho, Hyo-Wook Gil, Eun Young Lee

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引用次数: 0

Abstract

Background: In patients with type 2 diabetes mellitus (T2DM), diabetic kidney disease (DKD) is diagnosed based on clinical features. A kidney biopsy is used only in selected cases. This study aimed to reconsider the role of a biopsy in predicting renal outcomes.

Methods: Clinical and laboratory parameters and renal biopsy results were obtained from 237 patients with T2DM who underwent renal biopsies at Soonchunhyang University Cheonan Hospital between January 2000 and March 2020 and were analyzed.

Results: Of 237 diabetic patients, 29.1% had DKD only, 61.6% had non-DKD (NDKD), and 9.3% had DKD with coexisting NDKD (DKD/NDKD). Of the patients with DKD alone, 43.5% progressed to end-stage kidney disease (ESKD), while 15.8% of NDKD patients and 36.4% of DKD/NDKD patients progressed to ESKD (p < 0.001). In the DKD-alone group, pathologic features like ≥50% global sclerosis (p < 0.001), tubular atrophy (p < 0.001), interstitial fibrosis (p < 0.001), interstitial inflammation (p < 0.001), and the presence of hyalinosis (p = 0.03) were related to worse renal outcomes. The Cox regression model showed a higher risk of progression to ESKD in the DKD/NDKD group compared to the DKD-alone group (hazard ratio [HR], 2.73; p = 0.032), ≥50% global sclerosis (HR, 3.88; p < 0.001), and the degree of mesangial expansion (moderate: HR, 2.45; p = 0.045 and severe: HR, 6.22; p < 0.001).

Conclusion: In patients with T2DM, a kidney biopsy can help in identifying patients with NDKD for appropriate treatment, and it has predictive value.

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肾活检有助于预测 2 型糖尿病患者的肾脏预后。

背景：在 2 型糖尿病（T2DM）患者中，糖尿病肾病（DKD）是根据临床特征诊断出来的。肾活检仅用于部分病例。本研究旨在重新考虑活检在预测肾脏预后中的作用：分析2000年1月至2020年3月期间在顺天乡大学天安医院接受肾活检的237名T2DM患者的临床和实验室参数以及肾活检结果：结果：在237名糖尿病患者中，29.1%仅患有DKD，61.6%患有非DKD（NDKD），9.3%患有DKD并同时患有NDKD（DKD/NDKD）。在单纯 DKD 患者中，43.5% 进展为终末期肾病（ESKD），而在 NDKD 患者中，15.8% 进展为 ESKD，在 DKD/NDKD 患者中，36.4% 进展为 ESKD（p < 0.001）。在单纯DKD组中，≥50%的整体硬化（p＜0.001）、肾小管萎缩（p＜0.001）、肾间质纤维化（p＜0.001）、肾间质炎症（p＜0.001）和存在透明变性（p = 0.03）等病理特征与较差的肾脏预后有关。Cox回归模型显示，与单纯DKD组相比，DKD/NDKD组进展为ESKD的风险更高（危险比[HR]，2.73；p = 0.032），全身硬化≥50%（HR，3.88；p < 0.001），系膜扩张程度更高（中度：HR，2.45；p = 0.045；重度：HR，6.22；p < 0.001）：结论：在 T2DM 患者中，肾活检有助于识别 NDKD 患者，以便进行适当的治疗，而且具有预测价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Kidney Research and Clinical Practice UROLOGY & NEPHROLOGY-

CiteScore

4.60

自引率

10.00%

发文量

审稿时长

10 weeks

期刊介绍： Kidney Research and Clinical Practice (formerly The Korean Journal of Nephrology; ISSN 1975-9460, launched in 1982), the official journal of the Korean Society of Nephrology, is an international, peer-reviewed journal published in English. Its ISO abbreviation is Kidney Res Clin Pract. To provide an efficient venue for dissemination of knowledge and discussion of topics related to basic renal science and clinical practice, the journal offers open access (free submission and free access) and considers articles on all aspects of clinical nephrology and hypertension as well as related molecular genetics, anatomy, pathology, physiology, pharmacology, and immunology. In particular, the journal focuses on translational renal research that helps bridging laboratory discovery with the diagnosis and treatment of human kidney disease. Topics covered include basic science with possible clinical applicability and papers on the pathophysiological basis of disease processes of the kidney. Original researches from areas of intervention nephrology or dialysis access are also welcomed. Major article types considered for publication include original research and reviews on current topics of interest. Accepted manuscripts are granted free online open-access immediately after publication, which permits its users to read, download, copy, distribute, print, search, or link to the full texts of its articles to facilitate access to a broad readership. Circulation number of print copies is 1,600.