Clinical outcomes in patients with biopsy-proved diabetic nephropathy compared to isolated lupus or crescentic glomerulonephritis
Journal
Diabetes Research and Clinical Practice
Journal Volume
148
Pages
144-151
Date Issued
2019
Author(s)
Abstract
Aims: Diabetic nephropathy (DMN) is usually diagnosed clinically without pathology, and the prognosis of which compared to non-diabetic renal diseases has rarely been investigated especially in ethnic Chinese population. Here we reported the outcome of patients with biopsy-proved DMN compared to those with isolated crescentic glomerulonephritis (GN) or lupus nephritis (LN). Methods: This retrospective observational study included patients with DMN (n = 55), crescentic GN (n = 48) and LN (n = 82) from an original cohort of 987 adult patients who underwent kidney biopsy. The median follow-up period was 8.3 years. The Cox regression model was used to identify factors associated with the outcome measures of end-stage renal disease (ESRD) and all-cause mortality. Results: Patients with DMN and crescentic GN exhibited higher rates of ESRD than LN group (65.5%, 66.7% versus 32.9%, p < 0.001). After accounting for the competing risk of death, DMN versus LN, along with lower hemoglobin values, lower estimated glomerular filtration rates and severe proteinuria were independent predictors for ESRD. Patients with DMN and crescentic GN displayed higher mortality rates than LN patients following the development of ESRD (38.2% and 29.2% versus 9.8%, p < 0.001). Multivariate analysis showed old age (≧65 years) and lower serum albumin levels were independently associated with overall death. Conclusions: Patients with biopsy-proved DMN, but not crescentic GN, showed a greater risk of ESRD than LN counterparts. Given the grave renal prognosis of DMN, more meticulous follow-up is critical to ensure that best therapeutic strategies are used to avert progression to ESRD. ? 2019 Elsevier B.V.
SDGs
Other Subjects
albumin; hemoglobin; adult; aged; aging; albumin blood level; all cause mortality; Article; clinical outcome; cohort analysis; diabetic nephropathy; disease association; disease course; disease severity; end stage renal disease; estimated glomerular filtration rate; female; follow up; hemoglobin blood level; human; human tissue; kidney biopsy; lupus erythematosus nephritis; major clinical study; male; middle aged; mortality rate; mortality risk; observational study; outcome assessment; predictor variable; prognosis; proteinuria; rapidly progressive glomerulonephritis; retrospective study; acute disease; biopsy; chronic kidney failure; comparative study; complication; diabetic nephropathy; disease exacerbation; glomerulonephritis; kidney; lupus erythematosus nephritis; mortality; pathology; young adult; Acute Disease; Adult; Aged; Biopsy; Cohort Studies; Diabetic Nephropathies; Disease Progression; Female; Follow-Up Studies; Glomerulonephritis; Humans; Kidney; Kidney Failure, Chronic; Lupus Nephritis; Male; Middle Aged; Prognosis; Retrospective Studies; Young Adult
Publisher
Elsevier Ireland Ltd
Type
journal article