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Aim <p>Diabetic kidney disease (DKD) is a common complication of type 2 diabetes mellitus (T2DM), yet kidney biopsies in T2DM patients with atypical features often reveal nondiabetic kidney disease (NDKD).</p> Methods <p>This retrospective study evaluated 108 T2DM patients with atypical renal features who underwent kidney biopsy at SIUT, Karachi, between 1998 and 2019, with a minimum five-year follow-up.</p> Results <p>Despite good glycemic control in over 90% and a median diabetes duration of 1.25 years, 83.2% had nephrotic-range proteinuria and 59.2% had hypertension. Biopsies revealed NDKD in all cases, with focal segmental glomerulosclerosis (FSGS) being most common (32.4%), followed by membranous nephropathy (MN, 25%) and membranoproliferative glomerulonephritis (MPGN, 14.8%). Minimal change disease (MCD) showed the best prognosis, with 83.3% achieving sustained complete remission and no progression to dialysis. In contrast, MPGN had the poorest outcomes, with 75% progressing to end-stage kidney disease (ESKD) by year five (<i>p</i> = 0.01). Overall kidney survival dropped from 85.1% at six months to 60.1% at five years. Mortality was 4.6%, all due to sepsis.</p> Conclusion <p>The findings underscore the importance of early biopsy in T2DM patients with atypical renal presentations to identify NDKD, guide appropriate treatment, and improve long-term outcomes.</p>

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Glomerular Disease in Type 2 Diabetes: Unveiling Histological Patterns and Prognostic Significance

  • 期刊论文

  • 发表日期：

    2025年12月29日

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  • Tabassum Elahi,
  • Saima Ahmed,
  • Muhammed Mubarak

摘要

Aim

Diabetic kidney disease (DKD) is a common complication of type 2 diabetes mellitus (T2DM), yet kidney biopsies in T2DM patients with atypical features often reveal nondiabetic kidney disease (NDKD).

Methods

This retrospective study evaluated 108 T2DM patients with atypical renal features who underwent kidney biopsy at SIUT, Karachi, between 1998 and 2019, with a minimum five-year follow-up.

Results

Despite good glycemic control in over 90% and a median diabetes duration of 1.25 years, 83.2% had nephrotic-range proteinuria and 59.2% had hypertension. Biopsies revealed NDKD in all cases, with focal segmental glomerulosclerosis (FSGS) being most common (32.4%), followed by membranous nephropathy (MN, 25%) and membranoproliferative glomerulonephritis (MPGN, 14.8%). Minimal change disease (MCD) showed the best prognosis, with 83.3% achieving sustained complete remission and no progression to dialysis. In contrast, MPGN had the poorest outcomes, with 75% progressing to end-stage kidney disease (ESKD) by year five (p = 0.01). Overall kidney survival dropped from 85.1% at six months to 60.1% at five years. Mortality was 4.6%, all due to sepsis.

Conclusion

The findings underscore the importance of early biopsy in T2DM patients with atypical renal presentations to identify NDKD, guide appropriate treatment, and improve long-term outcomes.