Objective

There is limited discussion in the literature on clinical and pathological features of the rapidly progressive variant of diabetic nephropathy (DN). We aim to highlight the clinic-pathologic characteristics of biopsy proven DN in patients with type 2 diabetes (T2DM) and a rapid decline in glomerular filtration rate (GFR).

Methods

We conducted a cross sectional study of patients with rapidly declining GFR and biopsy proven isolated DN from 2012 to 2018. Data on clinical details, laboratory, and histologic findings was collected.

Results

A total of 46 patients were included; mean age was 49 ± 12.7 years with a predominantly male preponderance. Majority of the patients (82%) had hypertension and more than 40% required more than one antihypertensive medications. About half of the patients (47%) were on renin-angiotensin-system (RAS) inhibitors, and 70% were either overweight or obese. Almost half of the patients had HbA1c values greater than 7% and about 71% were on insulin. Mean urinary protein was 4.5 ± 2.6 g. Nodular and global glomerulosclerosis were the most common histologic findings, while 26.1% patients had crescents. During follow-up, 30% had one or more hospitalizations with congestive heart failure and 30% progressed to end-stage kidney disease (ESKD). Mean time to ESKD was 9.69 ± 17.87 months.

Conclusion

Younger age, higher body mass index, coexisting hypertension, overt proteinuria, and suboptimal glycemic and blood pressure control with underutilization of RAS inhibitors were prevalent in rapid decliners in DKD. Rapidly progressive diabetic kidney disease is a globally under-recognized entity, and this is the first experience shared from the South Asian region.

中文翻译：

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快速进展的糖尿病肾病：南亚经验

客观的

文献中关于快速进展型糖尿病肾病 (DN) 的临床和病理特征的讨论有限。我们旨在强调活检证实的 DN 在 2 型糖尿病 (T2DM) 和肾小球滤过率 (GFR) 快速下降患者中的临床病理特征。

方法

我们对 2012 年至 2018 年 GFR 迅速下降且活检证实为孤立性 DN 的患者进行了横断面研究。收集了有关临床细节、实验室和组织学发现的数据。

结果

共纳入 46 名患者；平均年龄为 49 ± 12.7 岁，男性占优势。大多数患者 (82%) 患有高血压，超过 40% 的患者需要一种以上的抗高血压药物。大约一半的患者 (47%) 服用肾素-血管紧张素系统 (RAS) 抑制剂，70% 的患者超重或肥胖。几乎一半的患者 HbA1c 值大于 7%，约 71% 的患者使用胰岛素。平均尿蛋白为 4.5 ± 2.6 g。结节性和全球性肾小球硬化是最常见的组织学发现，而 26.1% 的患者有新月体。在随访期间，30% 的患者因充血性心力衰竭住院 1 次或多次，30% 进展为终末期肾病 (ESKD)。ESKD 的平均时间为 9.69 ± 17.87 个月。

结论

较年轻的年龄、较高的体重指数、并存的高血压、明显的蛋白尿、血糖和血压控制不佳以及 RAS 抑制剂利用不足在 DKD 快速下降者中普遍存在。快速进展的糖尿病肾病是一个全球范围内未被充分认识的实体，这是南亚地区首次分享的经验。