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Abstract: FR-PO471

Renal Biopsy in Diabetic Patients: Preliminary Results of the Spanish Multicenter Study BIODIAB-GLOSEN-GEENDIAB

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Bermejo, Sheila, Parc de Salut Mar, Barcelona, Spain
  • Esparza, Noemí, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
  • Goicoechea, Marian, Hospital General Universitario Gregorio Marañon, Madrid, Spain
  • Ibernon, Meritxell, Hospital Sant Joan Despí Moises Broggi, Sant Joan Despí, Spain
  • Linares, Tania, Hospital Gregorio Marañón, Madrid, Spain
  • Coloma, Ana, Hospital San Pedro, Logro?o, BARCELONA, Spain
  • Martin, Adoración, Agencia Sanitaria Hospital de Ponient, Ameria, Spain
  • Garcia Osuna, Rosa, Hospital De Dalamos, Palamos, Spain
  • Diaz Encarnacion, Montserrat M., Fundación Pugvert, Barcelona, Spain
  • Garcia-Fernandez, Nuria, Clinica Universidad de Navarra, Pamplona, NAV, Spain
  • Martin Alemany, Nadia, University Hospital Dr. Josep Trueta, Girona, Spain
  • Lopez-Revuelta, Katia, Hospital Universitario Fundación Alcorcón, Alcorcon - Madrid, Spain
  • Elias, Sandra, Hospital Universitario Ramón y Cajal, Madrd, Spain
  • Agraz, Irene, Hospital valle d''Hebron, Barcelona, Spain
  • Pascual, Julio, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
  • Praga, Manuel, Hospital 12 de Octubre, Pozuelo De Alarcon, Spain
  • Fulladosa, Xavier, Hospital Universitari De Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
  • Soler, Maria Jose, Parc de Salut Mar. Fundació IMIM, Barcelona, Spain

Group or Team Name

  • GLOSEN, GLOMCAT, GEENDIAB
Background

The diabetic patient with kidney disease has a high prevalence of non-diabetic nephropathy(NDN) and the renal and patient survival in relation to the presence of diabetic nephropathy(DN) or NDN has not been widely studied. The objectives of the study are: to determine the capacity of the clinical and analytical data in the prediction in the histological result(DN or NDN) and to find differences in renal and patient survival.

Methods

Spanish retrospective descriptive multicenter study of the pathological result of biopsies performed in diabetic patients in 2002-2014.

Results

16 centers participated including 692 patients:511 men(73.8%), mean age of 62±12years, evolution of diabetes mellitus 10.5(3.7-15.3)years, serum creatinine 2,8±2,2mg/dl, glomerular filtration rate MDRD-4 of 37,7±26.8mL/min/1,73m2,glycosylated hemoglobin 7±1,7% and proteinuria of 3.91(1.1-5)gr/24h.
40.6% of patients had DN,48.6%NDN and 10.8%ND plus NDN. The most frequent NDN was nephroangiosclerosis(12.7%).
Multivariate logistic regression analysis: age(OR1,026,1,003-1,033,p=0.021),microhematuria(OR 1.523,1.047-2.214,p=0.028), creatinine(OR:1,149,1,045-1,164,p=0.004) and diabetic retinopathy (DR)(OR0.434,0.311-0.604p<0.001) were independently associated with NDN. We obtained the ROC curve model:(95% CI):0.683(0.636-0.731).
35.2%(n=184) of patients needed renal replacement therapy(RRT),47.3% of them presented DN,38.6% NDN and 14.1% DN and NDN. The overall mortality of the studied patients was 18.7%(n=98), of them 42% presented DN,46% NDN and 12% DN and NDN.
In the analysis of survival with Kaplan-Meier curves: Patients with DN or DN+NDN presented worse renal prognosis than NDN patients(p<0.001). In the multivariate analysis of Cox adjusted by confusing variables, DN was confirmed as a risk factor for RRT.

Conclusion

The most frequent NDN is nephroangiosclerosis. Elder patients with microhematuria, worse renal function and absence of DR are high risk for NDN. DN has worse renal prognosis than NDN. The histological diagnosis of renal involvement in the diabetic can facilitate an effective treatment and an improvement in the renal prognosis.

Funding

  • Government Support - Non-U.S.