Patients with diabetes on kidney biopsy may have non-diabetic kidney disease findings
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Key takeaways:
- Of patients with diabetes undergoing kidney biopsy, 37.2% had diabetic kidney disease alone.
- Researchers found 62.8% of patients also had non-diabetic kidney disease.
More than half of patients with diabetes undergoing kidney biopsy had additional findings other than diabetic kidney disease, according to published data from the Cleveland Clinic Florida.
“Given that patients clinically diagnosed with diabetes, in the absence of other compelling criteria for kidney biopsy, are often managed as if they have [diabetic kidney disease] DKD, our study aims to provide insight into the spectrum of kidney biopsy findings among patients with diabetes, to demonstrate how many patients with diabetes have DKD or non-DKD (with or without superimposed DKD),” Alvin G. Kwon, MD, MPH, of the Cleveland Clinic Foundation, wrote with colleagues.
Kwon and researchers from the Cleveland Clinic Kidney Biopsy Epidemiology Project conducted a cohort study of 1,242 patients with a history of diabetes between 2015 and 2021. The goal of the retrospective trial was to identify clinical parameters linked with non-diabetic kidney disease, defined as an alternative primary diagnosis on kidney biopsy.
Patients’ median age at the time of biopsy was 63 years. Overall, 58.8% were men, median hemoglobin A1c level was 6.7% and median serum creatinine level was 2.5 mg/dL.
Of patients in the study, 37.2% had diabetic kidney disease alone and 62.8% also had non-diabetic kidney disease, Kwon and colleagues found. Among patients with diabetic kidney disease and non-diabetic kidney disease, 24% had focal segmental glomerulosclerosis, according to the results. Overall, 13% had global glomerulosclerosis not otherwise specified, 9% had acute tubular necrosis, 8% had IgA nephropathy, 7% had antineutrophil cytoplasmic antibody vasculitis and 5% had membranous nephropathy.
Researchers found that some factors associated with having non-diabetic kidney disease on biopsy were the absence of retinopathy, lower A1c levels, higher eGFR, the presence of microalbuminuria and lower protein-to-creatinine ratio in urine samples.
“Our study has identified several clinical parameters associated with finding non-DKD in the setting of diabetes ... ,” the researchers wrote. They added, “This provides valuable information for clinicians on when kidney biopsy should be considered among diabetic patients to capture all etiologies of proteinuria and kidney dysfunction.”
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