title: Silent diabetic nephropathy.
abstract: OBJECTIVE
  To examine the risk of renal events in patients with biopsy-proven diabetic nephropathy (DN) and its possible associated factors.
  
  
  METHODS
  Clinical and histological data of 60 patients diagnosed with diabetic nephropathy were retrospectively collected. Patients with evidence or suspicion of other nephropathies were excluded from the study. The final event was defined as renal replacement therapy (RRT) initiation or progression of chronic kidney disease (CKD), according to the KDIGO 2012 definition of a decrease in CKD category and a decrease in GFR of 25% or more.
  
  
  RESULTS
  A total of 45 patients with a follow-up of at least 3 mo were included. Most of the patients presented type 2 DM, with a mean age of 58.3 years old. The time of evolution of DM was 9.6 ± 7.8 years, although in 13 patients, it was less than 5 years. A total of 62% of patients reached the final event in a median period of 3.4 years (95%CI: 2.1-4.7), with 21 of them requiring dialysis. The factors that were independently associated with renal survival were estimated glomerular filtration rate (eGFR) at the time of biopsy, cardiovascular disease (CVD) history and HbA1c less than 7%. Therefore, for each 10 mL/min per 1.73 m(2) reduction in eGFR, we obtained a DN progression risk of HR = 2 (1.3-3.0) (P = 0.001); patients with CVD were at greater risk for DN progression (HR = 2.8, 1.1-7.1, P = 0.032), and CKD patients with HbA1c < 7% demonstrated greater renal risk than patients with HbA1c ≥ 7%, with an HR of 2.9 (1.0-8.4) (P = 0.054).
  
  
  CONCLUSIONS
  A past history of CVD is a risk factor for DN progression. Levels of HbA1c less than 7% could favor an eGFR decrease in these patients.
authors: Katia López-Revuelta, Patricia Peña Galdo, Leticia Parejo, Unidad de Nefrología, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.
authors: Katia
authors: K
authors: López-Revuelta
authors: Katia López-Revuelta, Patricia Peña Galdo, Leticia Parejo, Unidad de Nefrología, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.
authors: Patricia Peña
authors: PP
authors: Galdo
authors: Katia López-Revuelta, Patricia Peña Galdo, Leticia Parejo, Unidad de Nefrología, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.
authors: Ramona
authors: R
authors: Stanescu
authors: Katia López-Revuelta, Patricia Peña Galdo, Leticia Parejo, Unidad de Nefrología, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.
authors: Leticia
authors: L
authors: Parejo
authors: Katia López-Revuelta, Patricia Peña Galdo, Leticia Parejo, Unidad de Nefrología, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.
authors: Carmen
authors: C
authors: Guerrero
authors: Katia López-Revuelta, Patricia Peña Galdo, Leticia Parejo, Unidad de Nefrología, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.
authors: Elia
authors: E
authors: Pérez-Fernández
keywords: Cardiovascular disease; Diabetic nephropathy; Histopathological diagnosis; Predictors of progression; Silent disease