title: Renal pathological implications in type 2 diabetes mellitus patients with renal involvement.
abstract: To investigate the renal pathological implications in type 2 diabetes mellitus patients with renal involvement.
  
  
  
  A total of 328 type 2 diabetes mellitus (T2DM) patients with renal involvement who underwent a renal biopsy and received follow-up for at least one year were recruited in our study. The patients were divided into the diabetic nephropathy (DN), non-diabetic renal disease (NDRD), and NDRD superimposed on DN groups based on the pathological diagnosis. Renal outcomes were defined by the initiation of renal replacement therapy or doubling of the serum creatinine. Kaplan-Meier analysis was used to compare renal survival, and Cox proportional hazard analysis was used to determine the predictors of renal outcomes in the DN group.
  
  
  
  Renal biopsy findings revealed that 188 patients (57.32%) had pure DN, 121 patients (36.89%) had NDRD alone, and 19 patients (5.79%) had NDRD superimposed on DN. The most frequent subclassification of NDRD was membranous nephropathy (MN). Compared with the NDRD and NDRD superimposed on DN groups, patients with pure DN had poorer renal function and lower renal survival rates. In the DN group, the five-year renal survival rates of glomerular classes of I, IIa, IIb, III and IV were 100%, 84.62%, 60%, 47.5% and 33.33%, respectively. Multivariate Cox proportional hazard analysis showed that the glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes, while interstitial fibrosis/inflammation and arteriolar hyalinosis were not independently associated with renal outcomes in the DN group.
  
  
  
  Making an accurate pathologic diagnosis by renal biopsy is crucial for diabetes mellitus (DM) patients with renal involvement. The findings of our present study indicated that patients with pure DN had poorer renal outcomes than patients with NDRD or NDRD superimposed on DN. The classification of glomerular lesions, proteinuria and serum creatinine were independent risk factors for renal outcomes in the DN group. More studies with large samples and longer time follow-up are needed to evaluate the relationship between pathological changes and clinical characteristics in T2DM patients who have renal involvement.
authors.affiliation: Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Division of Pathology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
authors.forename: Xiuhui
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
authors.forename: Zhicheng
authors.initials: Z
authors.lastname: Li
authors.affiliation: Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
authors.forename: Ruikun
authors.initials: R
authors.lastname: Guo
authors.affiliation: Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Yin
authors.affiliation: Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
authors.forename: Lichuan
authors.initials: L
authors.lastname: Yang
authors.affiliation: Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
authors.forename: Rongzheng
authors.initials: R
authors.lastname: Yue
authors.affiliation: Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
authors.forename: Baihai
authors.initials: B
authors.lastname: Su
authors.affiliation: Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
authors.forename: Songmin
authors.initials: S
authors.lastname: Huang
authors.affiliation: Division of Pathology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Xu
authors.affiliation: Division of Nephrology, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Cijiang
authors.initials: C
authors.lastname: He
authors.affiliation: Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China. Electronic address: liufangfh@163.com.
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Clinical features; Diabetic nephropathy; Non diabetic renal disease; Renal biopsy; Renal outcomes