title: Predicting non-diabetic renal disease in type 2 diabetic adults: The value of glycated hemoglobin.
abstract: OBJECTIVE
  The indications for renal biopsy in type 2 diabetes mellitus (T2D) are not well established. We investigated the prevalence, spectrum, and predictors of biopsy-proven non-diabetic renal disease (NDRD) in T2D.
  
  
  METHODS
  An observational, single-center, retrospective study of T2D adults who underwent renal biopsies (N = 51) over 10 years for nephrotic-range proteinuria, microscopic hematuria, or rapidly declining renal function.
  
  
  RESULTS
  Thirty-five (68.6%) biopsies were diagnostic of NDRD, and 16 (31.4%) revealed isolated diabetic nephropathy. The most common NDRDs were interstitial nephritis (20%), progressive crescentic glomerulonephritis (14%), membranous nephropathy (11%), and focal segmental glomerulosclerosis (11%). The odds for NDRD declined by 97% in the presence of diabetic retinopathy (P < 0.001). The deterioration of HbA1c during the year before biopsy predicted NDRD even after adjusting for diabetic retinopathy (OR, 7.65; 95% CI, 1.36-123.04; P = 0.003). A model based on the interaction between the HbA1c values 12 months before biopsy and the absolute change in these values during the preceding year predicted NDRD with 73.7% sensitivity and 75% specificity (AUC, 0.77; 95% CI, 0.59-0.94).
  
  
  CONCLUSIONS
  This study demonstrated a considerably high prevalence of NDRD in T2D adults undergoing renal biopsy. The absence of diabetic retinopathy, lower HbA1c values 12 months before biopsy and greater deterioration in HbA1c prior to biopsy predicted NDRD in T2D. Further studies are needed to validate the findings.
authors: Renal Unit, Heartlands Hospital, Bordesley Green East, Birmingham, UK. Electronic address: maria.pallayova@upjs.sk.
authors: Maria
authors: M
authors: Pallayova
authors: Renal Unit, Heartlands Hospital, Bordesley Green East, Birmingham, UK. Electronic address: azharuddin@doctors.org.uk.
authors: Azharuddin
authors: A
authors: Mohammed
authors: Department of Histopathology, Heartlands Hospital, Bordesley Green East, Birmingham, UK. Electronic address: gerald.langman@heartofengland.nhs.uk.
authors: Gerald
authors: G
authors: Langman
authors: Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country/National Institute for Health Research, University of Birmingham, Birmingham, UK; Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK. Electronic address: staheri@me.com.
authors: Shahrad
authors: S
authors: Taheri
authors: Renal Unit, Heartlands Hospital, Bordesley Green East, Birmingham, UK. Electronic address: indranil.dasgupta@heartofengland.nhs.uk.
authors: Indranil
authors: I
authors: Dasgupta
mesh_terms: D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D042241:Early Diagnosis; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009393:Nephritis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D057285:Precision Medicine; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015854:Up-Regulation
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Glycated hemoglobin; Non-diabetic renal disease; Renal biopsy; Renal disease; Type 2 diabetes mellitus