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Abstract: SA-PO461

Differentiating Non-Diabetic Kidney Diseases from Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients with Nephrotic Syndrome

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Jaturapisanukul, Solos, Navamindradhiraj University, Bangkok, Thailand
  • Laungchuaychok, Punnawit, Navamindradhiraj University, Bangkok, Thailand
  • Pongsitisak, Wanjak, Navamindradhiraj University, Bangkok, Thailand

Group or Team Name

  • Vajira Renal-Rheumatology-Autoimmune Disease Research Group.
Background

Nephrotic syndrome (NS) in patients with type 2 diabetes mellitus (T2DM) encompass both diabetic nephropathies (DN) and non-diabetic kidney diseases (NDKD). This study aims to investigate kidney biopsies in T2DM patients who had NS to determine the prevalence of NDKD and analyze characteristic features that are associated with NDKD. The objective is to develop a clinical prediction score that can differentiate any NDKD cases from DN alone.

Methods

This study was done as a single-center, retrospective, cross-sectional observational design, patients diagnosed with T2DM who underwent kidney biopsy due to NS at Vajira Hospital between 2013-2021. All patients received diagnoses of either DN, isolated NDKD, or NDKD superimposed on DN, which were confirmed through pathological examinations. To identify factors correlated with NDKD, a multiple logistic regression analysis was performed. Additionally, a clinical prediction score was developed by assigning weights to the predictors' coefficients in a multivariable logistic model.

Results

A total of 273 patients were enrolled in this study, with 89 patients (32%) DN alone, 69 patients (25%) NDKD superimposed on DN, and 115 patients (42%) NDKD alone. The most prevalent NDKD causes were IgA nephropathy. The absence of diabetic retinopathy (DR) (adj.OR 2.89; 95% CI 1.61-5.2; p<0.001), age>50 years (adj.OR 2.26; 95% CI 1.29-3.93; p=0.004), duration of DM < 6 years (adj.OR 2.02; 95% CI 1.14-3.57; p=0.015), and absence of hypertension (adj.OR 2.058; 95% CI 1.08-3.89; p=0.026) significant associations with NDKD. From these 4 predictors, a prediction score was derived, wherein a score >5 indicated a higher likelihood of NDKD (AUROC of 0.75, 95%CI 0.63-0.86)

Conclusion

The prevalence of any NDKD in T2DM with NS is 67%. No DR, Age > 50 years, duration of DM < 6 years, and absence of hypertension have significant association with NDKD. A new clinical prediction score for distinguishing any NDKD from DN alone can defer kidney biopsy.

Algorithm using Clinical Prediction score