title: Validation of a differential diagnostic model of diabetic nephropathy and non-diabetic renal diseases and the establishment of a new diagnostic model.
abstract: BACKGROUND
  The aims of the present study were to validate the differential diagnostic model of diabetic nephropathy (DN) and non-diabetic renal diseases (NDRD) established in 2003 and to establish a new diagnostic model suitable for the current clinical characteristics of DN.
  
  
  METHODS
  We examined 200 patients with Type 2 diabetes who underwent kidney biopsy from 2004 to 2012. The 2003 differential diagnostic model based on the data collected from 1993 to 2003 was evaluated by the diagnostic test and changes in the clinical differentiation parameters of DN and NDRD were analyzed. Logistic regression, receiver operating characteristics (ROC) curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analysis were applied.
  
  
  RESULTS
  The 2003 diagnostic model showed an accuracy of 77.5%. A significantly elevated incidence of hematuria, longer history of diabetes, and reduced level of glycated hemoglobin (HbA1c) were observed in the DN group from 2004 to 2012 compared with DN group from 1993 to 2003. Histories of diabetes mellitus (Dm), systolic blood pressure (Bp), HbA1c (Gh), hematuria (Hu), diabetic retinopathy (Dr), and hemoglobin (Hb) are independently related to DN. Thus, a new diagnostic model was constructed as follows: PDN  = exp (0.846 + 0.022 Dm + 0.033Bp + 2.050 Gh-2.664 Hu-0.078 Hb + 2.942Dr)/[1 + exp (0.846 + 0.022 Dm + 0.033 Bp + 2.050 Gh-2.664 Hu-0.078 Hb + 2.942 Dr)].Validation tests determined that the accuracy of the new model were 90.9%.
  
  
  CONCLUSIONS
  Changes in people with DN, clinical characteristics have reduced the diagnostic efficacy of the 2003 diagnostic model. The newly established model can provide a better, more current differentiation between DN and NDRD.
authors.affiliation: Department of Nephrology, Chinese PLA General Hospital (301 Hospital), Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center of Kidney Diseases (2013BAI09B05), Beijing, China.
authors.forename: Mo-yan
authors.initials: MY
authors.lastname: Liu
authors.forename: Xiang-mei
authors.initials: XM
authors.lastname: Chen
authors.forename: Xue-feng
authors.initials: XF
authors.lastname: Sun
authors.forename: Jian-hui
authors.initials: JH
authors.lastname: Zhou
authors.forename: Xue-guang
authors.initials: XG
authors.lastname: Zhang
authors.forename: Han-yu
authors.initials: HY
authors.lastname: Zhu
authors.forename: Yi-zhi
authors.initials: YZ
authors.lastname: Chen
authors.forename: Shu-wen
authors.initials: SW
authors.lastname: Liu
authors.forename: Ri-bao
authors.initials: RB
authors.lastname: Wei
authors.forename: Li
authors.initials: L
authors.lastname: Tang
authors.forename: Guang-yan
authors.initials: GY
authors.lastname: Cai
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Xue-yuan
authors.initials: XY
authors.lastname: Bai
mesh_terms: D000328:Adult; D003928:Diabetic Nephropathies / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007674:Kidney Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical
keywords: diabetic nephropathy; differential diagnosis; non-diabetic renal diseases; renal pathological diagnosis; type 2 diabetes; 关键词：糖尿病肾病，鉴别诊断，非糖尿病性肾脏疾病，肾脏病理诊断，2型糖尿病