Kidney Week

Abstract: SA-PO1144

Clinicopathological Characteristics and Outcomes of Nondiabetic Kidney Disease in Patients with Type 2 Diabetes

Session Information

• CKD: Patient-Oriented Care and Case Reports
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Zhou, Ting, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Ting Zhou

• Liu, Qiye, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Qiye Liu

• Wang, Niansong, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Niansong Wang, MD, PhD

• Fan, Ying, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Ying Fan, MD, PhD

Background

There is limited research on the characteristics and prognosis within the non-diabetic renal disease (NDRD) categories itself. We aim to investigate the clinicopathological characteristics, specific predictors and renal outcomes of various subtypes of NDRD in patients with Type 2 diabetes mellitus (T2D).

Methods

A total of 646 adult T2D patients who underwent renal biopsy were collected from Jan 2008 to Nov 2023. Among which 197 patients were diagnosed NDRD with different types of renal pathology. We conducted analysis on 123 patients with the top three subtypes of NDRD: IgA nephropathy (T2D-IgAN, n=52), membranous nephropathy (T2D-MN, n=48), and podocytopathies (T2D-Podo, n=23). Multivariate Cox regression models were used to analyze the predictors of renal outcomes in NDRD patients. The median follow-up time was 80 months (IQR: 62-102).

Results

Clinically, T2D-MN were older and had higher level of nephrotic proteinuria, total cholesterol as well as lower levels of serum albumin as compared to T2D-IgAN or T2D-Podo. T2D-MN patients were more likely to develop atherosclerotic plaques or unstable plaques in both carotid and lower extremity arteries (LEA), and are more prone to thromboembolism, infections as compared to other two groups. Pathologically, patients in T2D-IgAN group showed more pronounced glomerular sclerosis, interstitial inflammation and C3 deposit. Kaplan-Meier survival curves demonstrated that T2D-MN group had poorer renal survival, although it's not statistically significant. Multivariate Cox regression showed glomerular C3 deposit (HR 2.777, 95%CI 1.008-7.653), estimated glomerular filtration rate (eGFR) more than 60ml/min/1.73m² (HR 0.348, 95%CI 0.133-0.909) and T2D duration over 10 years (HR 3.866, 95%CI 1.326-11.275) were independent predictors for renal endpoints.

Conclusion

This is the first study to compare the clinicopathological characteristics of MN, IgAN, and podocytopathies and evaluate the renal outcome in T2D patients, which could help clinicians to initiate early intervention and prevent complications in those NDRD patients with poor prognosis. Novel immunosuppressants and biologics with minimized glucocorticoids strategies might bring more optimized options to NDRD patients.