Korean Journal of Nephrology 2009;28(6):588-594.
The Clinical Differentiations between Diabetic Nephropathy and Non-diabetic Renal Disease in Type 2 Diabetic Patients
Byung Soo Kim, M.D.1, Yoon Kyoung Chang, M.D.1, Ho Cheol Song, M.D.1, So Young Lee, M.D.1, Se Na Jang, M.D.1, Hyung Wook Kim, M.D.1, Young Shin Shin, M.D.1, Young Jin Choi, M.D.2, Dong Chan Jin, M.D.1 and Yong Soo Kim, M.D.1
Department of Internal Medicine1
and Pathology2
the Catholic University of Korea
원저 : 제2형 당뇨병 환자에서 당뇨병성 신증과 비당뇨병성 신질환의 임상적 차이
김병수1, 장윤경1, 송호철1, 이소영1, 장세나1, 김형욱1, 신영신1, 최영진2, 진동찬1, 김용수1
가톨릭대학교 의과대학 내과학교실1, 병리학교실2
Abstract
Purpose:It is important to differentiate non-diabetic renal diseases (NDRD) from diabetic nephropathy (DN) in type 2 diabetes. Our study was reviewing the clinical data and treatment strategies from diabetic patients performed renal biopsy to determine the clinical indicators suggestive of NDRD Methods:We reviewed the medical records of type 2 patients who underwent renal biopsy from Jan. 1995 to Dec. 2007. Results:Seventy four patients were included. Mean age was 52.0±12.5 years and 41 (55%) patients were male suddenly developed. Nephrotic syndrome [34 cases (46%)] was the leading reason for renal biopsy. There were 37 cases (50%) with a pathologic diagnosis of DN, 31 (42%) with NDRD, and 6 (8%) with concurrent DN and NDRD. IgA nephropathy (35%) was the most common lesion found in patients with NDRD. Thirty one patients (84%) with DN and 26 (84%) with NDRD had follow-up periods of more than 6 months. Of 26 patients with NDRD, 12 were treated with immune suppressants and 6 achieved complete remission. Thirteen patients with DN and one with NDRD developed end-stage renal disease. Patients with NDRD tended to show shorter duration of diabetes, lower systolic blood pressure (SBP) and lower serum triglyceride, and had significantly lower incidence of diabetic retinopathy (DR). In the univariate regression analysis, diabetes duration, SBP, triglyceride and DR showed statistically significance. And SBP and DR were identified as independent correlating factors by multivariate regression analysis. Conclusion:In this study, the absence of retinopathy could predict the presence NDRD among NIDDM patients presenting with renal disease. And additional disease-specific therapies may be helpful for the patients with NDRD.
Key Words: Biopsy, Diabetic nephropathy, Diagnosis, differential, Type 2 diabetes mellitus


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