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Abstract: PO1567

When to Biopsy Type 2 Diabetes Mellitus (DM2)

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Sosa Barrios, Haridian, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
  • Burguera, Victor, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
  • García, María, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
  • Saiz, Ana, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
  • Villacorta Perez, Javier, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
  • Conde, Guillermo Fernández, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
  • Fernandez-Lucas, Milagros, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
  • Rivera Gorrin, Maite, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain
Background

DM2 patients may have diabetic (DN) or non-diabetic renal disease (NDRD) and a histological diagnosis is needed. There is no clear consensus on when to biopsy, but a predictive model was recently published(1).

Methods

Aim: Assess NDRD prevalence, histology and apply the predictive score in our cohort.
Methods: Retrospective analysis of native kidney (NK) biopsies performed in our center from 2016 to 2020. Data collected included DM history, retinopathy, peripheral vascular disease (PVD), insulin prescription, proteinuria, BMI and hematuria >10 cells/HPF. A score >3 was highly suggestive of DN and would preclude renal biopsy (RB).

Results

62 of 274 NK RB’s had DM, 66.1% males with a mean age of 64±13.7 (range 23-83). Mean estimated glomerular filtration rate (MDRD4) was 41.4±26.5 ml/min/1.73m2 (range 6-98) with mean BMI 27.9 (range 18-41). Mean proteinuria was 4453 mg/g (range 4-36249) and 51.6% had microhematuria. 51.6% had a DM history >10 and 28.3% < 5 years since diagnosis. 82.3% did not have retinopathy, 11.3% had neuropathy and 48.4% were on insulin. 27.4% had PVD, 6.5 % ischaemic cardiomyopathy (ICD) and 3 had a previous stroke.
RB indications: 21 nephrotic syndrome, 2 nephritic syndrome, 6 proteinuria-hematuria, 18 non nephrotic proteinuria, 7 renal impairment and 8 AKI.
Histology: 22 had DN (38.6%), 35 NDRD (61.4%) and insufficient in 5. NDRD included crescentic glomerulonephritis, membranous, FSGS, chronic tubulointertitial nephritis, ATN, IgA GN, minimal change, amyloid, hiperfiltration, glomerular sclerosis and chronic inespecific lesions.
Longstanding DM (>10 y), retinopathy, neuropathy and PVD were independent predictors of DN (p value 0.02, 0.01, 0.001 and 0.001). Neither hematuria, nephrotic range proteinuria nor ICD were significant.
Score: Patients with a score>3 had DN except 2 (oxalate crystals and cast nephropathy). 70.2% with a score<3 had NDRD and 84% of those with <1 did not have DN.

Conclusion

61.4% do not have DN and NDRD is underdiagnosed. The score had excellent correlation with DN and could be efficient on RB decision making process in these patients. Validation in multicentric studies is desirable.

1.García-Martín F. et al. When to perform renal biopsy in patients with type 2 diabetes mellitus? Predictive model of non-diabetic renal disease. 10.1016/j.nefro.2019.07.005