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25-04-2024 | Diabetic Nephropathy | Nephrology – Original Paper

Non-diabetic nephropathy in diabetic patients: incidence, HbA1c variability and other predictive factors, and implications

Authors: Bülent Demirelli, Burcu Boztepe, Elif Gülcan Şenol, Başak Boynueğri, Yelda Deligöz Bildacı, Gülistan Gümrükçü, Mustafa Canbakan, Melike Betül Öğütmen

Published in: International Urology and Nephrology

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Abstract

Purpose

Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) in the population. In patients with diabetes mellitus, the incidence of non-diabetic nephropathy (NDNP) has been estimated to range from 3% to 69.5%. Personal judgment is frequently employed while deciding whether or not to do a kidney biopsy (KB) on diabetic patients. NDNP alters the prognosis and course of treatment for people with DM. In our study, we examined the incidence of NDNP concurrent with the progression of diabetes mellitus, as well as the laboratory and clinical indicators that could be utilized to forecast it.

Methods

A retrospective analysis of 76 diabetic patients who underwent KB was conducted. Based on the pathological diagnoses of these patients, they were categorized as DNP (diabetic nephropathy) or NDNP. The definition of HbA1c variability was determined by calculating the mean HbA1c and the average value of the HbA1c measurements, as well as the standard deviation (SD) for each participant.

Results

NDNP was detected in 50% of 76 patients. Among patients with NDNP, 36.8% had focal segmental glomerulosclerosis (FSGS), 23.6% had membranous glomerulonephritis, and 7.8% had IgA nephritis. The NDNP group exhibited significantly higher rates of female gender, absence of diabetic retinopathy, shorter time to diagnosis of diabetes mellitus, chronic kidney disease, and proteinuria, less intensive medication for diabetes mellitus, presence of hematuria and leukociduria, immunological serological marker positivity, and non-HbA1C variability. Risk factors for predicting non-diabetic nephropathy, as determined by multivariate analysis, included female gender, the absence of diabetic retinopathy, non-HbA1c variability and a positive immunological serological test.

Conclusion

In this study, a significant number of diabetic patients with chronic kidney disease were diagnosed with NDNP. Identifying these patients allows for treatment of the specific underlying disease. Factors such as the absence of DR, non-HbA1c variability, female gender, and immunological serological test positivity can predict NDNP and guide the clinician’s decision on kidney biopsy. Further prospective studies are warranted to validate the efficacy of potential predictive factors like HbA1c variability.
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Metadata
Title
Non-diabetic nephropathy in diabetic patients: incidence, HbA1c variability and other predictive factors, and implications
Authors
Bülent Demirelli
Burcu Boztepe
Elif Gülcan Şenol
Başak Boynueğri
Yelda Deligöz Bildacı
Gülistan Gümrükçü
Mustafa Canbakan
Melike Betül Öğütmen
Publication date
25-04-2024
Publisher
Springer Netherlands
Published in
International Urology and Nephrology
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-024-04066-w
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