Author(s): Prakash J, Sen D, Usha, Kumar NS
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Abstract OBJECTIVES: A wide spectrum of non-diabetic renal diseases (NDRD) are reported to occur in patients with type 2 diabetes mellitus. However, the prevalence and nature of NDRD in type 2 diabetics is not widely documented in our country. Therefore, the objectives of this study were to analyse prevalence and spectrum of non-diabetic renal disease in type 2 diabetic patients. METHODS: Two hundred sixty type 2 diabetic with clinical renal diseases were screened for evidence of NDRD, between April 1997 to March 1999. Renal disease other than diabetic nephropathy was found in 32 (12.3\%) patients. Their (male 23; female 9) age ranged between 35-72 (mean 54.15+/-10.3) years. The duration of diabetes was < 5 years in 14 (43.7\%), between 5-9 years in 8 (25\%) and > 10 years in 10 (31.2\%) patients. RESULTS: The presenting clinical syndromes were : chronic renal failure 15 (47\%), acute nephritic syndrome 6 (18.7\%), nephrotic syndrome 5 (15.6\%), acute renal failure 4 (12.5\%) and rapidly progressive glomerulonephritis (RPGN) in 2 (6.2\%) cases. Overall, incidence of glomerular (46.8\%) and tubulo-interstitial lesions (53.2\%) were almost equal in type 2 diabetes patients. The spectrum of non-diabetic renal diseases includes : primary isolated glomerulopathy 12 (37.5\%); mesangioproliferative GN superimposed on diabetic glomerulosclerosis (DGS) in 3 (9.3\%); acute tubulo-interstitial nephropathy (TIN) 4 (12.5\%); chronic TIN 10 (31.25\%) and three patients had chronic pyelonephritis. Diabetic retinopathy was absent in 22 (69\%) cases where 10 (31\%) patients had background diabetic retinopathy. None of the patients with non-diabetic glomerular disease had diabetic retinopathy, except two who had DGS in addition to mesangioproliferative GN on renal biopsy. The background diabetic retinopathy was seen in 47\% of patients with TIN without clinical evidence of diabetic nephropathy. The recovery of renal function or clinical improvement was observed in 47\% of patients with NDRD with institution of appropriate treatment. CONCLUSION: The prevalence of NDRD was 12.3\% in our type 2 diabetic patients. Both non-diabetic glomerulopathy (47\%) and tubulo-interstitial nephropathy (53\%) can occur with nearly equal frequency in such patients. It is also gratifying to diagnose and treat NDRD in type 2 diabetics in selected cases.
This article was published in J Assoc Physicians India
and referenced in Journal of Nephrology & Therapeutics