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Article

Whether Renal Pathology Is an Independent Predictor for End-Stage Renal Disease in Diabetic Kidney Disease Patients with Nephrotic Range Proteinuria: A Biopsy-Based Study

by
Tingli Wang
1,2,
Junlin Zhang
1,2,
Yiting Wang
1,2,
Lijun Zhao
1,2,
Yucheng Wu
1,2,
Honghong Ren
1,2,
Yutong Zou
1,2,
Rui Zhang
1,2,
Huan Xu
3,
Zhonglin Chai
4,
Mark E. Cooper
4,
Jie Zhang
5 and
Fang Liu
1,2,*
1
Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
2
Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu 610041, China
3
Division of Pathology, West China Hospital of Sichuan University, Chengdu 610041, China
4
Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
5
Laboratory of Transplant Engineering and Immunology, Ministry of Health, Regenerative Medicine Research Center, Chengdu 610041, China
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2023, 12(1), 88; https://doi.org/10.3390/jcm12010088
Submission received: 21 November 2022 / Revised: 9 December 2022 / Accepted: 14 December 2022 / Published: 22 December 2022
(This article belongs to the Section Nephrology & Urology)
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Abstract

Aims: To investigate whether renal pathology is an independent predictor for end-stage renal disease (ESRD) in diabetic kidney diseases (DKD) with nephrotic range proteinuria. Methods: A total of 199 DKD patients with nephrotic range proteinuria underwent renal biopsy and were divided into an ESRD group and a non-ESRD group. A Kaplan–Meier analysis was used to compare renal survival rate, and univariate and multivariate Cox proportional hazard analyses were used to determine the predictors of the ESRD. Results: The mean age of included patients was 51.49 ± 9.12 years and 113 patients (56.8%) progressed to ESRD. The median follow-up period was 16 (12–28) months. The glomerular pathology class III is the most common type (54.3%). In the Kaplan–Meier analysis, compared with patients without ESRD, patients with ESRD had a longer duration of diabetes (≥6 years), lower eGFR (<60 mL/min/1.73 m2), lower albumin (<30 g/L), lower hemoglobin (<120 g/L), and a higher grade of glomerular stage (class III + IV vs. class I + II) (p < 0.05). The hemoglobin and e-GFR, but not the histopathological damage, were significantly associated with a higher risk of ESRD in both the univariate and multivariate Cox analyses. Conclusions: In patients with diabetic kidney disease characterized by nephrotic range proteinuria, histopathological damage (glomerular alterations, interstitial fibrosis and tubular atrophy (IFTA), interstitial inflammation, and arteriolar hyalinosis) is not associated with poor renal outcomes, but hemoglobin and e-GFR could predict poor renal outcomes.
Keywords: diabetic kidney diseases; end-stage renal disease; nephrotic range proteinuria; renal biopsy diabetic kidney diseases; end-stage renal disease; nephrotic range proteinuria; renal biopsy

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MDPI and ACS Style

Wang, T.; Zhang, J.; Wang, Y.; Zhao, L.; Wu, Y.; Ren, H.; Zou, Y.; Zhang, R.; Xu, H.; Chai, Z.; et al. Whether Renal Pathology Is an Independent Predictor for End-Stage Renal Disease in Diabetic Kidney Disease Patients with Nephrotic Range Proteinuria: A Biopsy-Based Study. J. Clin. Med. 2023, 12, 88. https://doi.org/10.3390/jcm12010088

AMA Style

Wang T, Zhang J, Wang Y, Zhao L, Wu Y, Ren H, Zou Y, Zhang R, Xu H, Chai Z, et al. Whether Renal Pathology Is an Independent Predictor for End-Stage Renal Disease in Diabetic Kidney Disease Patients with Nephrotic Range Proteinuria: A Biopsy-Based Study. Journal of Clinical Medicine. 2023; 12(1):88. https://doi.org/10.3390/jcm12010088

Chicago/Turabian Style

Wang, Tingli, Junlin Zhang, Yiting Wang, Lijun Zhao, Yucheng Wu, Honghong Ren, Yutong Zou, Rui Zhang, Huan Xu, Zhonglin Chai, and et al. 2023. "Whether Renal Pathology Is an Independent Predictor for End-Stage Renal Disease in Diabetic Kidney Disease Patients with Nephrotic Range Proteinuria: A Biopsy-Based Study" Journal of Clinical Medicine 12, no. 1: 88. https://doi.org/10.3390/jcm12010088

APA Style

Wang, T., Zhang, J., Wang, Y., Zhao, L., Wu, Y., Ren, H., Zou, Y., Zhang, R., Xu, H., Chai, Z., Cooper, M. E., Zhang, J., & Liu, F. (2023). Whether Renal Pathology Is an Independent Predictor for End-Stage Renal Disease in Diabetic Kidney Disease Patients with Nephrotic Range Proteinuria: A Biopsy-Based Study. Journal of Clinical Medicine, 12(1), 88. https://doi.org/10.3390/jcm12010088

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