ArticleWorld journal of nephrology2025
Predictors of non-diabetic kidney disease in diabetics: A Saudi Arabian perspective.
Article in World journal of nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDiabetic patients with atypical presentation are often challenging in terms of diagnosis and management. Kidney biopsy is not routinely done in diabetics, and clinicians are always in a dilemma in such a scenario to decide whether to do a biopsy or not. Since non-diabetic kidney diseases (NDKD) are common, and some patients may have NDKD superimposed on diabetic kidney diseases (DKD), therefore, kidney biopsy may be warranted to rule out NDKD.
aimTo determine the prevalence of NDKD, DKD, or mixed lesions, identify predictors of NDKD, and investigate renal and patient survival, as well as factors associated with these outcomes.
methodsThis retrospective observational study was conducted on patients with biopsy-proven NDKD, DKD, and mixed lesions (having both NDKD and DKD). Binary logistic regression models were constructed to identify predictors of NDKD. Kaplan-Meier survival analysis was performed to compare time to kidney failure and patient survival across the three histological groups. Multivariable Cox proportional hazards regression was used to identify clinical and pathological factors associated with kidney failure and all-cause mortality.
resultsA total of 103 biopsies were analyzed. Sixty-four (62.1%) had NDKD alone or mixed lesions. The most common NDKD pathologies were interstitial nephritis in 12 (29.2%), focal segmental glomerulosclerosis in 10 (24.4%), and immune complex-mediated glomerulonephritis in five (12.2%) patients. Compared to DKD, NDKD was associated with significantly lower odds of proteinuria > 3.5 g/day [odds ratio (OR), 0.02;
conclusionNDKD and mixed lesions are frequent in diabetic patients. These histological lesions carry distinct prognostic implications. Clinical features such as a shorter diabetes duration, absence of retinopathy, anemia, and elevated creatinine levels suggest NDKD and warrant biopsy. NDKD had better renal and patient survival rates, while mixed lesions had the worst outcomes. Older age, hypoalbuminemia, retinopathy, arteriosclerosis, and elevated creatinine were key predictors of mortality.
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