Abstract: FR-PO645

Renal Biopsies in Diabetic Patients: Hematuria or Absence of Retinopathy Do Not Indicate Non Diabetic Renal Disease: A 10-Year Single-Center Experience

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Chemouny, Jonathan M., AP-HP, Hopital Bichat, Paris, France
  • Barba, Christophe, AP-HP, Hopital Bichat, Paris, France
  • Daugas, Eric, AP-HP, Hopital Bichat, Paris, France
  • Sannier, Aurelie, AP-HP, Hopital Bichat, Paris, France
  • Vrtovsnik, Francois, AP-HP, Hopital Bichat, Paris, France
Background

Diabetic nephropathy (DN) is usually a presomptive diagnosis based on clinical and biological evidences. However, renal biopsies (RB) may be performed in diabetic patients with glomerular proteinuria lacking classical features of DN and/or in patients with diabetes and another disease with potential renal involvement who could benefit from specific therapy. We compared the frequencies of Non Diabetic Renal Disease (NDRD) according to the RB indications to assess if RB performed for atypical findings are justified.

Methods

144 RB were performed in diabetic patients with glomerular proteinuria in our center in ten years and divided into two groups: Group 1 (G1): atypical findings (absence of diabetic retinopathy (DR), hematuria (HU), rapid eGFR decline, rapid increase of proteinuria or sudden nephrotic syndrome); Group 2 (G2): clinical and/or biological features of suggesting NDRD. We compared frequencies of NDRD and RB related adverse events in each group.

Results

68 patients were identified in G1 and 76 in G2. Gender, age, high blood pressure, serum creatinine, urinary protein-to-creatinine ratio, HU, DR, renin-angiotensin system blockade and diabetes duration were not different between both groups. Glycated hemoglobin was higher in G1 (7.8±2.2 vs 7.1±1.4, p=0.04). NDRD was diagnosed in 7 % of patients in G1 and 50% in G2 (p<0.001). None of the 37 patients who underwent RB for HU, and/or absence of DR had NDRD. Adverse events were more frequent in G1 than in G2 (10% vs 1%, p=0.027) (Table).

Conclusion

Absence of DR or presence of HU should not be the only motivation to indicate RB in diabetic patients as they convey an increased risk of adverse event without any benefit.

Renal biopsies indicationn (%)Non diabetic renal disease,n (%)Adverse events, n (%)
Atypical findings68 (100)5 (7)7 (10)
Haematuria and/or absence of diabetic retinopathy, n (%)37 (53)0 (0)5 (14)
CKD progression, n (%)15 (21)2 (13)1 (7)
Recently increased proteinuria, n (%)10 (14)1 (10)1 (10)
Miscelleanous, n (%)
(Previously unknown diabetes, Sudden nephrotic syndrom or Stage 5 CKD)
8 (11)4 (50)0 (0)
Other indications76 (100)38 (50)1 (1)
Systemic disease with potential renal involvement, n (%)
(Hyper IgG4 disease, Systemic lupus erythematosus without history of renal flare, Bullous pemphigoid, Autoimmune polyglandular syndrome, Sarcoidosis and ankylosing spondylitis, HBV, HCV, HIV seropositivity, Tuberculosis, or Amyloidosis)
26 (35)12 (46)1 (4)
Monoclonal gammopathy, n (%)15 (20)3 (20)0 (0)
Acute kidney injury, n (%)13 (18)6 (46)0 (0)
Known renal disease, n (%)
(ANCA-associated disease, Lupus nephritis or IgA nephropathy/Henoch-Schonlein purpura)
8 (11)6 (75)0 (0)
Miscelleanous, n (%)
(Anti-nuclear antibodies or Anti-neutrophil cytoplasmic antibodies, Proteinuria pre-diabetes onset or Cutaneous purpura)
14 (19)11 (78)0 (0)

Funding

  • Clinical Revenue Support