Clinicopathological Spectrum of Diabetic and Non-diabetic Renal Lesions in Patients with Diabetes Mellitus: An Experience from A Tertiary Care Center.

Background & objective: Diabetic patients often develop lesions called non-diabetic renal diseases (NDRD), whose prognostic and therapeutic implications vary from diabetic nephropathy (DN). Since early identification of NDRD is associated with a better prognosis, we aimed to understand its spectrum.

Methods: One hundred and thirty-four patients were included in a cross-sectional study. Their clinical, and laboratory data and indications for biopsy were recorded. Two cores of renal tissue were studied under light microscopy and immunofluorescence; patients were classified into NDRD, NDRD+DN, and DN groups.

Results: Of all the patients studied, five were diagnosed with type 1 diabetes mellitus (DM1), and the rest were type 2 diabetes mellitus (DM2). Overall, the male-to-female ratio was 3:1. The Mean age of NDRD patients was the greatest, and males were predominant in all three groups. CKD was the most common presentation. Except for significantly greater proteinuria and hematuria in the DN and NDRD groups respectively, others were not different. Infection-related glomerulonephritis was the most common lesion among the NDRD+DN group, whereas IgA nephropathy and acute tubulointerstitial nephritis were frequent in the NDRD group.

Conclusion: Based on our findings, renal biopsy should be considered in all those diabetic patients with lesser onset duration presenting with hematuria, no/minimal retinopathy, and minimal proteinuria. A precise diagnosis helps in providing timely therapy for NDRD and prolonging renal and patient survival.