Clinical and histological correlation of diabetic nephropathy

• Published in: Saudi journal of kidney diseases and transplantation Vol. 28; no. 4; pp. 836 - 841
• Main Authors: Sagar, Radha, Reddy, Sandeep, Gandhe, Sridhar, Rajaram, K. G., Afroz, Tameem
• Format: Journal Article
• Language: English
• Published: Riyadh, Saudi Arabia Saudi Center for Organ Transplantation 01-07-2017; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Age; Biopsy; Care and treatment; Cellular biology; Classification; Development and progression; Diabetes; Diabetic nephropathies; Diabetic nephropathy; Epidemiology; Glucose; Hospitals; Hypertension; Kidney biopsy; Kidney diseases; Medical prognosis; Microscopy; Morphology; Morphology (Biology); Nephrology; Pathology; Patients; Population; Renal replacement therapy; Urine; اعتلال الكلى السكري; الطب السريري; علم الأنسجة; مرض السكري
• ISSN: 1319-2442; 2320-3838

Renal failure in diabetes is a common cause of renal replacement therapy. The
affected kidney goes through various changes in all compartments progressively. The
classification of diabetic nephropathy is based on glomerular lesions and displays a heterogeneous
morphology. Abnormalities in tubulointerstitial and vascular compartments are important in
assessing the outcome of these patients. We applied the new pathologic classification of diabetic
nephropathy by Tervaert et al to classify the renal damage in diabetes. This is a prospective study
over two years. We analyzed 74 renal biopsies in diabetic patients, both type-1 and type-2.
Indications for biopsy were rapid onset of proteinuria, absence of retinopathy, presence of
hematuria, active urine sediment, and rapid unexplained deterioration of renal function. Biopsy
was done to rule out nondiabetic renal disease or any other associated pathology with diabetic
nephropathy. In our study, 53 patients were male and 21 patients were female. Age ranged from
27 to 82 years. The mean ± standard deviation age at the time of the biopsy was 54.09 ± 11.59
years. Mean duration of diabetes was 10.2 years. Proteinuria ranged from 1 to 26 g. Type-111
histopathological lesion was the most common lesion observed in our series. There was a
correlation between the degree of tubulo-interstitial damage with renal function. There was no
correlation between the fundal changes and degree of proteinuria with the histological class of
diabetic nephropathy. Application of the classification by Tervaert et al to diabetic lesions reduces
the inter-observer variability and also helps in prognosticating and management of patients.