An evaluation of renal biopsy in type-II diabetic patients.
OBJECTIVE
To determine the renal damage in type-II diabetic patients, who underwent renal biopsy for impaired renal functions and its role in overall patient management.


METHODS
Descriptive, cross-sectional study.


METHODS
The Kidney Postgraduate Centre, Karachi, Pakistan from January 2000 to May 2005.


METHODS
Histopathological evaluation of 73 patients of type-II Diabetes mellitus were included who underwent renal biopsy. Renal biopsy was performed when a renal disease other than diabetic nephropathy was suspected because of the presence of haematuria, nephrotic syndrome, non-nephrotic proteinuria < 3 gms/day in the absence of retinopathy, rapidly progressive glomerulonephritis and renal insufficiency of unknown origin. On the basis of light microscopy and immunofluorescence, three groups of patients were defined. Group I was characterized by diabetic glomerulosclerosis (DGS) only, group II by the prevalence of vascular changes, while group III had sub-groups IIIa (DGS co-existing with nondiabetic renal diseases) and IIIb (non-diabetic renal diseases without DGS).


RESULTS
Among the 73 patients studied, 20 (27.3%) had diabetic glomerulosclerosis alone (group I), 17 (23.3%) showed occurrence of vascular changes (group II), and 36 (49.3%) had non-diabetic renal diseases (group III). Mean serum creatinine level was significantly greater in group II than in group I and III (p < 0.001). Amount of proteinuria and the presence of haematuria did not show a statistically significant difference in groups I, II and III. The systolic and diastolic blood pressure was higher in groups II as compared to group I and III (p < 0.001). The percentage of sclerotic glomeruli, tubular injury and interstitial inflammation in group II were significantly greater than group I and III (p < 0.001).


CONCLUSIONS
Type-II diabetic patients undergoing renal biopsy for impaired renal functions constituted a heterogeneous group of renal damage. This study emphasized the usefulness of renal biopsy for determining the pattern of renal damage that would aid in the overall management of the patients.
Arif
Muhammad
M
Department of Pathology, Karachi Medical and Dental College, Nazimabad, Karachi. dr.marif@hotmail.com
Arif
Muhammad Khubaib
MK
Arif
Muhammad Sohaib
MS
D000704:Analysis of Variance; D001706:Biopsy; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors