Histopathological evaluation of kidney disease in patients with diabetes mellitus

Kidney biopsy findings in diabetes



diabetic nephropathy, diabetic retinopathy, hematuria, kidney biopsy, non-diabetic kidney disease, proteinuria


Introduction: Non-diabetic kidney disease (NDKD), a treatable condition, is common in diabetic patients with atypical clinical presentations. Present study aimed to find out histopathological diagnosis of kidney disease in type 2 Diabetes mellitus (T2DM) with such presentations.

Method: This was a hospital-based cross-sectional study conducted in the Nephrology department, Bir hospital, Nepal from Aug 2019 to January 2021. Total 29 diabetic patients with atypical presentations, the rapid rise of proteinuria alone (n=5), with microscopic hematuria (n=6), with impaired renal function (n=8), and the rapid rise of creatinine with (n=8) or without (n=2) microscopic hematuria were included. The baseline information was recorded and a kidney biopsy was performed.

Result: The mean age of patients was 52.6±10.4 years and 75.9% were male. Diabetic retinopathy (DR) was absent in 82.8% of patients. NDKD was present alone in 20.7% and superimposed on diabetic kidney disease (DKD) in 34.5% with total NDKD in 55.2% and isolated DKD in 44.8% of patients. NDKD were glomerulonephritis(75%) with membranous nephropathy (25%) and IgA nephropathy (25%) patients. The significant difference between NDKD and isolated DKD was only the duration of diabetes < 5 years in 61.5% of isolated DKD and >5 years in 81.2% patients with NDKD (p=0.018). DR was absent in 100% of patients with isolated NDKD, 80% of class III, and 62.5% of class IV DKD.

Conclusion: NDKD is common in T2DM with renal involvement and regardless of retinopathy or duration of diabetes, kidney biopsy should be routinely performed in these patients with atypical clinical presentation.

Author Biographies

Juju Shres, National Medical Sciences, Bir Hospital, Mahaboudha Kathmandu, Nepal.

DM (Resident), Dept of Nephrology

Kashyap Dahal , National Medical Sciences, Bir Hospital, Mahaboudha Kathmandu, Nepal.

Senior Consultant Nephrologist

Anil Baral

Assoc. Prof of Nephrology

Rajani Hada, National Medical Sciences, Bir Hospital, Mahaboudha Kathmandu, Nepal.