The Value of Renal Biopsy in Non-Insulin-Dependent Diabetes Mellitus in Singapore over the Past Two Decades
Objective: This study on the prevalence of diabetic nephropathy (DN) and coexistence of non-diabetic renal disease (NDRD) in a cohort of 255 non-insulin-dependent diabetes mellitus (NIDDM) patients aims to determine the value of performing renal biopsies in these patients and elucidate the factors w...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Karger Publishers
2020-05-01
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| Series: | Kidney Diseases |
| Subjects: | |
| Online Access: | https://www.karger.com/Article/FullText/505624 |
| _version_ | 1819202563752329216 |
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| author | Keng Thye Woo Choong Meng Chan Cynthia Lim Jason Choo Yoke Mooi Chin Esther Wei Ling Teng Irene Mok Jia Liang Kwek Chieh Suai Tan Hui Zhuan Tan Alwin H.L. Loh Hui Lin Choong Han Kim Tan Grace S.L. Lee Evan Lee Kok Seng Wong Puay Hoon Tan Marjorie Foo |
| author_facet | Keng Thye Woo Choong Meng Chan Cynthia Lim Jason Choo Yoke Mooi Chin Esther Wei Ling Teng Irene Mok Jia Liang Kwek Chieh Suai Tan Hui Zhuan Tan Alwin H.L. Loh Hui Lin Choong Han Kim Tan Grace S.L. Lee Evan Lee Kok Seng Wong Puay Hoon Tan Marjorie Foo |
| author_sort | Keng Thye Woo |
| collection | DOAJ |
| description | Objective: This study on the prevalence of diabetic nephropathy (DN) and coexistence of non-diabetic renal disease (NDRD) in a cohort of 255 non-insulin-dependent diabetes mellitus (NIDDM) patients aims to determine the value of performing renal biopsies in these patients and elucidate the factors which could affect their progression to end-stage renal disease (ESRD). Methods: Among 255 NIDDM patients, 93 had DN alone, 69 had NDRD alone, and the remaining 93 had DN plus NDRD (mixed group). The indications for renal biopsy were based on clinical suspicion of superimposed NDRD, including heavy or rapidly increasing proteinuria, renal impairment even though diabetes is of relatively short duration, rapidly declining renal function, and presence of hematuria with dysmorphic red blood cells suggesting presence of glomerulonephritis. Results: The following were predictors of ESRD: high systolic BP at biopsy, longer duration of diabetes, heavy proteinuria, and presence of diabetic retinopathy. Comparing patients in the NDRD group with the DN group and the mixed group, the NDRD group had lower serum creatinine and higher eGFR with lower urinary proteinuria and higher serum albumin at presentation and on follow-up. Kimmelstiel-Wilson nodules were associated with a poorer prognosis leading to a higher occurrence of ESRD among patients with DN. Conclusion: Renal biopsy is of value in indicating the prognosis of NIDDM patients with DN based on the diabetic lesions. For NIDDM patients with atypical course and suspicion of associated NDRD, a renal biopsy would enable us to diagnose the underlying NDRD and offer appropriate therapy. Most nephrologists would consider renal biopsy for an NIDDM patient based on clinical indications like atypical clinical course and suspicion of an associated NDRD, but they would not perform a routine renal biopsy like for a CKD patient, unless it is for a research indication. |
| first_indexed | 2024-12-23T04:06:01Z |
| format | Article |
| id | doaj.art-f86c259cdd2c4390a47a67431cffdc4b |
| institution | Directory Open Access Journal |
| issn | 2296-9381 2296-9357 |
| language | English |
| last_indexed | 2024-12-23T04:06:01Z |
| publishDate | 2020-05-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Kidney Diseases |
| spelling | doaj.art-f86c259cdd2c4390a47a67431cffdc4b2022-12-21T18:00:38ZengKarger PublishersKidney Diseases2296-93812296-93572020-05-0111510.1159/000505624505624The Value of Renal Biopsy in Non-Insulin-Dependent Diabetes Mellitus in Singapore over the Past Two DecadesKeng Thye WooChoong Meng ChanCynthia LimJason ChooYoke Mooi ChinEsther Wei Ling TengIrene MokJia Liang KwekChieh Suai TanHui Zhuan TanAlwin H.L. LohHui Lin ChoongHan Kim TanGrace S.L. LeeEvan LeeKok Seng WongPuay Hoon TanMarjorie FooObjective: This study on the prevalence of diabetic nephropathy (DN) and coexistence of non-diabetic renal disease (NDRD) in a cohort of 255 non-insulin-dependent diabetes mellitus (NIDDM) patients aims to determine the value of performing renal biopsies in these patients and elucidate the factors which could affect their progression to end-stage renal disease (ESRD). Methods: Among 255 NIDDM patients, 93 had DN alone, 69 had NDRD alone, and the remaining 93 had DN plus NDRD (mixed group). The indications for renal biopsy were based on clinical suspicion of superimposed NDRD, including heavy or rapidly increasing proteinuria, renal impairment even though diabetes is of relatively short duration, rapidly declining renal function, and presence of hematuria with dysmorphic red blood cells suggesting presence of glomerulonephritis. Results: The following were predictors of ESRD: high systolic BP at biopsy, longer duration of diabetes, heavy proteinuria, and presence of diabetic retinopathy. Comparing patients in the NDRD group with the DN group and the mixed group, the NDRD group had lower serum creatinine and higher eGFR with lower urinary proteinuria and higher serum albumin at presentation and on follow-up. Kimmelstiel-Wilson nodules were associated with a poorer prognosis leading to a higher occurrence of ESRD among patients with DN. Conclusion: Renal biopsy is of value in indicating the prognosis of NIDDM patients with DN based on the diabetic lesions. For NIDDM patients with atypical course and suspicion of associated NDRD, a renal biopsy would enable us to diagnose the underlying NDRD and offer appropriate therapy. Most nephrologists would consider renal biopsy for an NIDDM patient based on clinical indications like atypical clinical course and suspicion of an associated NDRD, but they would not perform a routine renal biopsy like for a CKD patient, unless it is for a research indication.https://www.karger.com/Article/FullText/505624diabetic nephropathyrenal biopsynon-diabetic renal diseaseretinopathy |
| spellingShingle | Keng Thye Woo Choong Meng Chan Cynthia Lim Jason Choo Yoke Mooi Chin Esther Wei Ling Teng Irene Mok Jia Liang Kwek Chieh Suai Tan Hui Zhuan Tan Alwin H.L. Loh Hui Lin Choong Han Kim Tan Grace S.L. Lee Evan Lee Kok Seng Wong Puay Hoon Tan Marjorie Foo The Value of Renal Biopsy in Non-Insulin-Dependent Diabetes Mellitus in Singapore over the Past Two Decades Kidney Diseases diabetic nephropathy renal biopsy non-diabetic renal disease retinopathy |
| title | The Value of Renal Biopsy in Non-Insulin-Dependent Diabetes Mellitus in Singapore over the Past Two Decades |
| title_full | The Value of Renal Biopsy in Non-Insulin-Dependent Diabetes Mellitus in Singapore over the Past Two Decades |
| title_fullStr | The Value of Renal Biopsy in Non-Insulin-Dependent Diabetes Mellitus in Singapore over the Past Two Decades |
| title_full_unstemmed | The Value of Renal Biopsy in Non-Insulin-Dependent Diabetes Mellitus in Singapore over the Past Two Decades |
| title_short | The Value of Renal Biopsy in Non-Insulin-Dependent Diabetes Mellitus in Singapore over the Past Two Decades |
| title_sort | value of renal biopsy in non insulin dependent diabetes mellitus in singapore over the past two decades |
| topic | diabetic nephropathy renal biopsy non-diabetic renal disease retinopathy |
| url | https://www.karger.com/Article/FullText/505624 |
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