title: Rapidly progressive renal failure in type 2 diabetes in the tropical environment: a clinico-pathological study.
abstract: BACKGROUND
  Rapid decline of renal function in a diabetic suggests the presence of a nondiabetic kidney disease (NDKD). We designed a prospective study to evaluate the factors associated with a rapid decline in renal function in patients with type 2 diabetes.
  
  
  METHODS
  Over a 2 and a half year period, all patients with type 2 diabetes who presented with documented doubling of serum creatinine in less than 4 weeks or recently diagnosed advanced renal failure were identified. Patients with prerenal causes, urinary tract obstruction, or systemic disease causing renal failure were not included. Renal histology was studied in all cases.
  
  
  RESULTS
  A total of 26 patients satisfied the inclusion criteria. Over 75% had serum creatinine >4 mg/dL at presentation and 62% were dialysis dependent. Renal histology showed mixed lesions of diabetic nephropathy (DN) and NDKD in 11 cases, only DN in nine, and pure NDKD in six. Diffuse proliferative glomerulonephritis (DPGN) was the commonest NDKD (27% cases), all on a background of DN. History of preceding cutaneous or pharyngeal infection was available in five cases. The proportion of postinfectious glomerulonephritis in diabetics with rapidly progressive renal failure was over six times that of the nondiabetic adult RPRF population during the study period. Four patients had acute interstitial nephritis and three showed crescentic glomerulonephritis. Other lesions included amyloidosis, atheroembolic disease, and renal papillary necrosis (one each). The frequency of microscopic hematuria and retinopathy was similar in those with pure DN and NDKD. Four out of seven cases with DPGN showed partial recovery whereas the other three remained unchanged.
  
  
  CONCLUSIONS
  About two-thirds of patients with type 2 diabetes presenting with rapid decline of renal function in a tropical environment show NDKD. The high incidence of postinfectious glomerulonephritis in this group is possibly related to the high prevalence of skin and soft tissue infections; and could contribute to progressive kidney disease.
authors.affiliation: Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Moger
authors.forename: S Karthik
authors.initials: SK
authors.lastname: Kumar
authors.forename: Vinay
authors.initials: V
authors.lastname: Sakhuja
authors.forename: Kusum
authors.initials: K
authors.lastname: Joshi
authors.forename: Ranjana
authors.initials: R
authors.lastname: Walker
authors.forename: Harbir S
authors.initials: HS
authors.lastname: Kohli
authors.forename: Kamal
authors.initials: K
authors.lastname: Sud
authors.forename: Krishan L
authors.initials: KL
authors.lastname: Gupta
authors.forename: Vivekanand
authors.initials: V
authors.lastname: Jha
mesh_terms: D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D014329:Tropical Climate