Clinical Predictors of Non-diabetic Renal Disease and Role of Renal Biopsy in Diabetic Patients with Renal Involvement: A Single Centre Review

Figures & data

Table 1. NDRD with or without DN.

	Isolated NDRD	Mixed lesions	NDRD ± DN
	(n/%)	(n/%)	(%)
Acute interstitial nephritis	9/45.0	11/52.4	48.8
Glomerulonephritides
Minimal change disease	3		7.3
IgA nephropathy	2		4.9
Diffuse proliferative	1		2.4
glomerulonephritis
Focal segmental	1		2.4
glomerulosclerosis
Lupus nephritis	1		2.4
	(8/40.0)		(19.4)
Acute tubular necrosis	1/5.0	0	2.4
Chronic pyelonephritis	0	2/9.5	4.9
Hypertensive nephrosclerosis	2/10.0	8/38.1	24.4
Total	20	21	100.0

Note: NDRD, non-diabetic renal diseases; DN, diabetic nephropathy.

Table 2. Patient demographics and laboratory data between three groups of patients.

	Pure DN (Group I)	Isolated NDRD (Group II)	Mixed lesions (Group III)	p-Value
n (%)	69 (62.7%)	20 (18.2%)	21 (19.1%)
Age (years)	52.0 ± 1.1	57.5 ± 2.1	56.0 ± 2.4	NS
Sex (M/F)	44/25	12/8	8/13
Race
Malay	19	9	15
Chinese	25	7	4
Indian	25	4	2
Duration of diabetes (years)	13.6 ± 0.91^a	8.2 ± 1.44^a	10.6 + 1.44	0.017^a (I vs. II)
24-hour urine protein (g/day)	7.5 ± 0.66	6.8 ± 1.64	5.9 ± 1.12	NS
Serum albumin (g/L)	26.4 ± 1.10	25.0 ± 2.10	28.1 ± 1.57	NS
Serum creatinine (μmol/L)	254.6 ± 21.32^b	425.9 ± 80.64^b	309.9 ± 41.9	0.013^b (I vs. II)
HbA1c (%)	8.2 ± 0.27	7.5 ± 0.48	7.9 ± 0.41	NS
ESR (mm/h)	67.3 ± 4.56	91.7 ± 13.50	62.5 ± 10.07	NS
Kidney size (cm)	10.6 ± 0.14	10.8 ± 0.24	10.4 ± 0.23	NS

Data are mean ± SEM. ^a,bSignificant p-value between group I and group II.

Note: NDRD, non-diabetic renal diseases; DN, diabetic nephropathy.

Table 3. Association between clinical markers and renal pathology.

	Pure DN (group I)	Isolated NDRD (group II)	Mixed lesions (group III)	p-Value	OR (95% CI)
Duration of diabetes
>10 years (n = 63)	47	6	10	0.002 (I vs. II)	4.99 (1.69–14.71)
≤10 years (n = 47)	22	14	11	NS (I vs. III or II vs. III)
Acute renal failure
Present (n = 12)	2	9	1	<0.0001 (I vs. II)	II vs. I 27.41 (5.21–144.09)
Absent (n = 98)	67	11	20	0.03 (II vs. III)	II vs. III 16.36 (1.83–146.67)
				NS (I vs. III)
Microscopic hematuria
Present (n = 54)	28	16	10	0.002 (I vs. II)	II vs. I 5.71 (1.73–18.92)
				0.03 (II vs. III)	II vs. III 4.4 (1.10–17.68)
Absent (n = 55)	40	4	11	NS (I vs. III)
Diabetic retinopathy
Present (n = 67)	50	6	11	<0.0001 (I vs. II)	I vs. II 16.67 (4.25–65.41)
Absent (n = 22)	5	10	7	0.003 (I vs. III)	I vs. III 6.36 (1.70–23.83)
				NS (II vs. III)

Note: NDRD, non-diabetic renal diseases; DN, diabetic nephropathy; OR, odd ratio; CI, confidence interval.

Table 4. The sensitivity and specificity of clinical markers.

Clinical marker	Sensitivity (%)	Specificity (%)	Likelihood ratio
Predicting DN
Diabetic retinopathy	84	63	2.23
Duration of diabetes mellitus >10 years	63	70	2.11
Predicting NDRD
Microscopic hematuria	80	57	1.87
Acute renal failure	45	97	13.50

Note: NDRD, non-diabetic renal diseases; DN, diabetic nephropathy.