Clinical and pathological risk factors for renal prognosis in patients with biopsy-proven diabetic nephropathy classified as chronic kidney disease stage 4

doi:10.3969/j.issn.1006-7795.2022.05.007

Abstract

Abstract: Objective To investigate the pathological types, clinical manifestations and prognosis of patients with pathologically diagnosed diabetic nephropathy (DN) classified as chronic kidney disease (CKD) stage 4. Methods The clinical data of pure DN patients with biopsy-proven diagnosis with CKD stage 4, were selected from the Department of Nephrology of China-Japan Friendship Hospital during January 2002 to March 2021.The primary endpoint was set to the composite of progression to end stage renal disease (ESRD) or death. Patients were divided into the stable and progressive groups according to the occurrence of endpoint events. Univariate analysis and Cox regression were used to analyze the relationship between clinical manifestations, pathological types and prognosis of patients. Results A total of 53 patients were included in the study, including 19 cases of type Ⅱb, 32 cases of type Ⅲ, and 2 cases of type Ⅳ. The median follow-up was 24 (2.0,46.5) months, and the median renal survival was 17.3 (8.7,25.8) months. The primary end point event occurred in33 patients and 5 of them died. Median renal survival was 16.5 (9.6,23.5) months in the non-continued angiotensin-converting enzyme inhibitors (ACEI)/angiotensin Ⅱ receptor blockers (ARB) group (n=32) and 20.7 (8.8,25.8)months in the continued ACEI/ARB group (n=21).The multivariate Cox regression analysis showed thatnone of triglyceride, control of blood glucose and pathological class were independent prognostic factors for renal survival(P＞0.05). Conclusion There was no significant relationship between pathological type and DN renal survival time. The continued use of ACEI/ARB drugs could not effectively delay the progression of advanced CKD in DN. There was no significant correlation between different pathological classification and prognosis of DN during CKD stage 4. ACEI/ARB therapy has a prolonged but no significant benefit for renal survival. Patients with DN should be diagnosed and treated early.

Key words: diabetic nephropathy, renal biopsy, chronic kidney disease stage 4, pathology, prognosis

CLC Number:

Yu Tianyu, Jiang Shimin, Gao Hongmei, Zou Guming, Li Wenge. Clinical and pathological risk factors for renal prognosis in patients with biopsy-proven diabetic nephropathy classified as chronic kidney disease stage 4[J]. Journal of Capital Medical University, 2022, 43(5): 707-712.

0
/ / Recommend

Add to citation manager EndNote|Reference Manager|ProCite|BibTeX|RefWorks

URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2022.05.007

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2022/V43/I5/707

References

[1] Ruiz-Ortega M, Rayego-Mateos S, Lamas S, et al. Targeting the progression of chronic kidney disease[J]. Nat Rev Nephrol, 2020, 16(5): 269-288.
[2] IDF. IDF diabetes Atlas[M/OL]. 9th ed. Brussels: International Diabetes Federation, 2019. https://diabetesatlas.org/atlas/ninth-edition/.
[3] de Boer I H, Rue T C, Hall Y N, et al. Temporal trends in the prevalence of diabetic kidney disease in the United States[J]. JAMA, 2011, 305(24): 2532-2539.
[4] Yang Y, Zhang Z, Zhuo L, et al. The spectrum of biopsy-proven glomerular disease in China: a systematic review[J]. Chin Med J (Engl), 2018, 131(6): 731-735.
[5] Fiorentino M, Bolignano D, Tesar V, et al. Renal biopsy in 2015--from epidemiology to evidence-based indications[J]. Am J Nephrol, 2016, 43(1): 1-19.
[6] Umanath K, Lewis J B. Update on diabetic nephropathy: core curriculum 2018[J]. Am J Kidney Dis, 2018, 71(6): 884-895.
[7] Inker L A, Schmid C H, Tighiouart H, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C[J]. N Engl J Med, 2012, 367(1): 20-29.
[8] Tervaert T W C, Mooyaart A L, Amann K, et al. Pathologic classification of diabetic nephropathy[J]. J Am Soc Nephrol, 2010, 21(4): 556-563.
[9] 于天宇, 姜世敏, 杨悦, 等. 慢性肾脏病4期糖尿病肾病患者临床病理与预后分析[J]. 临床肾脏病杂志, 2020, 20(9): 717-721.
[10] Hoshino J, Mise K, Ueno T, et al. A pathological scoring system to predict renal outcome in diabetic nephropathy[J]. Am J Nephrol, 2015, 41(4/5): 337-344.
[11] Stefan G, Stancu S, Zugravu A, et al. Histologic predictors of renal outcome in diabetic nephropathy: beyond renal pathology society classification[J]. Medicine (Baltimore), 2019, 98(27): e16333.
[12] Okada T, Nagao T, Matsumoto H, et al. Histological predictors for renal prognosis in diabetic nephropathy in diabetes mellitus type 2 patients with overt proteinuria[J]. Nephrology (Carlton), 2012, 17(1): 68-75.
[13] Bohle A, Wehrmann M, Bogenschütz O, et al. The pathogenesis of chronic renal failure in diabetic nephropathy. Investigation of 488 cases of diabetic glomerulosclerosis[J]. Pathol Res Pract, 1991, 187(2/3): 251-259.
[14] Thomsen O F, Andersen A R, Christiansen J S, et al. Renal changes in long-term type 1 (insulin-dependent) diabetic patients with and without clinical nephropathy: a light microscopic, morphometric study of autopsy material[J]. Diabetologia, 1984, 26(5): 361-365.
[15] 吴雪怡, 李航, 文煜冰, 等. 2型糖尿病肾病患者肾脏病理改变与预后的临床队列研究[J]. 中华肾脏病杂志, 2014, 30(9): 650-655.
[16] Haller H, Viberti G C, Mimran A, et al. Preventing microalbuminuria in patients with diabetes: rationale and design of the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study[J]. J Hypertens, 2006, 24(2): 403-408.
[17] Qiao Y, Shin J I, Sang Y Y, et al. Discontinuation of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in chronic kidney disease[J]. Mayo Clin Proc, 2019, 94(11): 2220-2229.
[18] Brenner B M, Cooper M E, de Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy[J]. N Engl J Med, 2001, 345(12): 861-869.