SP116
NON DIABETIC RENAL DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Introduction and Aims: Diabetic nephropathy (DN) is one of the major complications of type 2 diabetes mellitus and is reported as the leading cause of end stage renal disease worldwide. The diagnosis of DN is mostly clinical and kidney biopsy is usually not indicated. However, not all nephropathies in diabetic patients are due to DN. The prevalence of non-diabetic nephropathy (NN) is presumed to exist in between 8% and 93% .This depends on the selection criteria, indications and availability of renal biopsy. It is important to distinguish between NN and DN because some NN are reversible, whereas DN rarely improves. The aim of our study is to evaluate the indications of renal biopsy and to determine predictors of NN.

Methods: We included type 2 diabetes mellitus patients in whom renal biopsies were performed from January 1988 to May 2014.

Results: Forty nine patients were included. The mean age at biopsy was 51, 8 years old. Twenty nine of patients were male and 20 were female. The median duration of diabetes was 62, 2 months. The indications for renal biopsy were proteinuria without diabetic retinopathy in 20 cases, unexplained decline of renal function in 12 cases, un explained hematuria in 13 cases, proteinuria with short duration of diabetes in 17 cases and presence of extrarenal signs in 6 cases. According to renal biopsy findings, isolated DN was found in 13 cases, NN superimposed on DN in 12 cases and isolated NN was found in 22 cases. The most common NN found were focal segmental glomerulosclerosis, followed by membranous nephropathy and IgA nephropathy. In univariate analysis independence of insulin therapy (p=0,007), absence of diabetic retinopathy (p=0,019), absence of diabetic neuropathy (p=0,033) and absence of dyslipidaemia (p=0,007) were found to be significant clinical predictors of NN. In multivariate analysis, only absence of diabetic retinopathy (OR=0,027, 95%CI=0,346-0,101) and presence of glomerular hematuria (OR=0,048, 95%CI=0,004-0,717) were independent predictors of NN.

Conclusions: Unfortunately, patients with NN are often designed at having DN because of overlapping features of glomerulopathies. It is important to differentiate these pathologies because there is an overwhelming number of NNs which are potentially curable. That’s why renal biopsy should be recommended for type 2 diabetic patients with renal involvement, especially in those without diabetic retinopathy and having glomerular hematuria.