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Histological Evidence of Diabetic Kidney Disease Precede Clinical Diagnosis.

ABSTRACT: BACKGROUND:In the absence of a histological diagnosis, persistent albuminuria is globally accepted as the main diagnostic criteria for diabetic kidney disease (DKD). METHODS:In the present retrospective study, we evaluated data from an Italian cohort of 42 deceased diabetic donors (mainly with type 2 diabetes). Using the kidney biopsies obtained at the time of donation to evaluate single or double allocation based on Karpinski score, we determined the prevalence of histological lesions attributable to diabetes. RESULTS:All 42 donors presented with proteinuria in the normal range and an estimated glomerular filtration rate (eGFR) (chronic kidney disease [CKD]-EPI) >60 mL/min/1.73 m2. A kidney biopsy was available for 36 patients; of these, one was not interpretable and 32 showed histopathological lesions consistent with DKD and encompassing all histological classes. Thus, we found a relatively high proportion of histologically proven DKD that had been clinically undiagnosed, as none of the patient had significant proteinuria and eGFR <60 mL/min/1.73 m2. CONCLUSIONS:The data we present here support the need to implement routine kidney biopsies in normoalbuminuric diabetic subjects in the early stages of CKD. Such strategy may help to improve risk stratification in diabetic patients and guide therapeutic decisions during the early stages of the disease.

SUBMITTER: Comai G

PROVIDER: S-EPMC6691362 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Histological Evidence of Diabetic Kidney Disease Precede Clinical Diagnosis.

Comai Giorgia G Malvi Deborah D Angeletti Andrea A Vasuri Francesco F Valente Sabrina S Ambrosi Francesca F Capelli Irene I Ravaioli Matteo M Pasquinelli Gianandrea G D'Errico Antonietta A Fornoni Alessia A La Manna Gaetano G

American journal of nephrology 20190605 1

<h4>Background</h4>In the absence of a histological diagnosis, persistent albuminuria is globally accepted as the main diagnostic criteria for diabetic kidney disease (DKD).<h4>Methods</h4>In the present retrospective study, we evaluated data from an Italian cohort of 42 deceased diabetic donors (mainly with type 2 diabetes). Using the kidney biopsies obtained at the time of donation to evaluate single or double allocation based on Karpinski score, we determined the prevalence of histological le ...[more]

PMID: 31167184

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Project description:Diabetic kidney disease (DKD) is a major burden in elderly patients with type 2 diabetes (T2DM). Low estimated glomerular filtration rate (eGFR+, <?60 mL/min/1.73 m2) and albuminuria (Alb+) are essential for the diagnosis of DKD, but their association with clinical variables and quality of care may be influenced by ageing.Here we investigated the association of clinical variables and quality of care measures with eGFR+ and Alb+ in 157,595 T2DM individuals participating to the Italian Association of Clinical Diabetologists (AMD) Annals Initiative, stratified by age.The prevalence of eGFR+ and Alb+ increased with ageing, although this increment was more pronounced for low eGFR. Irrespective of age, both the eGFR+ and Alb + groups had the worst risk factors profile when compared to subjects without renal disease, showing a higher prevalence of out-of target values of HbA1c, BMI, triglycerides, HDL-C, blood pressure and more complex cardiovascular (CVD) and anti-diabetic therapies, including a larger use of insulin In all age groups, these associations differed according to the specific renal outcome examined: male sex and smoking were positively associated with Alb+ and negatively with eGFR+; age and anti-hypertensive therapies were more strongly associated with eGFR+, glucose control with Alb+, whereas BMI, and lipid-related variables with both abnormalities. All these associations were attenuated in the older (>?75 years) as compared to the younger groups (<?65 years; 65-75 years), and they were confirmed by multivariate analysis. Notably, Q-score values <?15, indicating a low quality of care, were strongly associated with Alb+ (OR 8.54; P?<?0.001), but not with eGFR+.In T2DM patients, the prevalence of both eGFR and Albuminuria increase with age. DKD is associated with poor cardiovascular risk profile and a lower quality of care, although these associations are influenced by the type of renal abnormality and by ageing. These data indicate that clinical surveillance of DKD should not be unerestimated in old T2DM patients.

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Histological Evidence of Diabetic Kidney Disease Precede Clinical Diagnosis.

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Histological Evidence of Diabetic Kidney Disease Precede Clinical Diagnosis.

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