Clinical predictors differentiating non-diabetic renal diseases from diabetic nephropathy in a large population of type 2 diabetes patients.
OBJECTIVE
Non-diabetic renal diseases (NDRDs) are associated with better renal outcomes than diabetic nephropathy (DN). This study was conducted to determine the common clinical markers predicting NDRDs in type 2 diabetes patients.


METHODS
Patients with type 2 diabetes mellitus who underwent a renal biopsy were screened. Eligible patients were categorized into two groups: DN group and NDRD group. Patient's clinical characteristics and laboratory data were collected. Logistic regression analysis was performed to identify risk factors for NDRD development, and the diagnostic performance of these variables was evaluated.


RESULTS
The study included 248 patients, 96 (38.71%) in the DN group and 152 (61.29%) in the NDRD group. Patients in the NDRD group had a shorter duration of DM and higher hemoglobin, estimated glomerular filtration rate, and urine osmotic pressure values as well as a higher incidence of glomerular hematuria than patients in the DN group. In the NDRD patients, the most common pathological type was membranous nephropathy (55, 36.18%). Absence of retinopathy (OR, 44.696, 95% CI, 15.91-125.566), glomerular hematuria (OR, 9.587, 95% CI, 2.027-45.333), and DM history ⩽5years (OR, 4.636, 95% CI, 1.721-12.486) were significant and independent risk factors for the development of NDRD (P<0.01). Absence of retinopathy achieved the overall highest diagnostic efficiency with a sensitivity of 92.11% and specificity of 82.29%. Glomerular hematuria had the highest specificity (93.75%).


CONCLUSIONS
Shorter duration of diabetes (⩽5years), absence of retinopathy, and presence of glomerular hematuria were independent indicators associated with NDRDs, indicating the need for renal biopsy.
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory, National Clinical Research Center of Kidney Diseases, Beijing, China.
Zheyi
Z
Dong
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory, National Clinical Research Center of Kidney Diseases, Beijing, China.
Yuanda
Y
Wang
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory, National Clinical Research Center of Kidney Diseases, Beijing, China.
Qiang
Q
Qiu
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory, National Clinical Research Center of Kidney Diseases, Beijing, China.
Xueguang
X
Zhang
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory, National Clinical Research Center of Kidney Diseases, Beijing, China. Electronic address: zhangl301@163.com.
Li
L
Zhang
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory, National Clinical Research Center of Kidney Diseases, Beijing, China.
Jie
J
Wu
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory, National Clinical Research Center of Kidney Diseases, Beijing, China.
Ribao
R
Wei
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory, National Clinical Research Center of Kidney Diseases, Beijing, China.
Hanyu
H
Zhu
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory, National Clinical Research Center of Kidney Diseases, Beijing, China.
Guangyan
G
Cai
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory, National Clinical Research Center of Kidney Diseases, Beijing, China.
Xuefeng
X
Sun
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory, National Clinical Research Center of Kidney Diseases, Beijing, China. Electronic address: xmchen301@126.com.
Xiangmei
X
Chen
D000328:Adult; D000368:Aged; D001706:Biopsy; D002681:China / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000473:pathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
Diabetic nephropathy; Diabetic retinopathy; Differential diagnosis; Non-diabetic renal diseases; Type 2 diabetes mellitus