scholarly journals Normoalbuminuric Diabetic Kidney Disease- Need for Renal Biopsy? An Autopsy Study on Western Indian Population

2020 ◽  
Vol 7 (10) ◽  
pp. A483-490
Author(s):  
Sonal Paul ◽  
Nitin M Gadgil ◽  
Anitha Padmanabhan
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Interstitial Fibrosis ◽  
Clinical Manifestations ◽  
Vascular Lesions ◽  
Diabetic Patients ◽  
Autopsy Study ◽  
Tubular Atrophy ◽  
Glomerular Lesions

Introduction: Persistent albuminuria and glomerular filtration rate are considered as the gold standard for the diagnosis of Diabetic Nephropathy (DN). Methods: In this autopsy study, we evaluated data from a cohort of 67 patients with Type 2 Diabetes Mellitus. We determined the histological prevalence of DN irrespective of the clinical manifestations of renal disease. Patients were stratified by proteinuria and estimated glomerular filtration rate(eGFR). The glomerular, interstitial and vascular lesions were scored as per the established histopathologic classification for DN. Results: 55 of the 67 patients had clinical as well as histological lesions consistent with DN. 12 patients had histological lesions of DN at autopsy but no clinical evidence of proteinuria, including microalbuminuria in their lifetime.4 of these patients had maintained eGFR. There was no difference in the glomerular lesions in patients with normoalbuminuria regardless of the eGFR. However,50% of the patients with low eGFR showed presence of interstitial fibrosis and tubular atrophy while no interstitial lesions were noted in patients with normoalbuminuria and maintained eGFR. Significant amount of arteriosclerosis was noted in the normoalbuminuric low eGFR patients. Haematuria was significantly associated with proteinuric low GFR patients. Conclusion: Histological evidence of DN may be seen even in the absence of clinical manifestations, suggesting that, in diabetic kidneys some amount of glomerular and tubulointerstitial damage has already occurred before the onset of proteinuria. Hence, there is a need for routine kidney biopsies in diabetic patients with normoalbuminuria. This will help in the timely diagnosis and appropriate management in the early stages of DN.

scholarly journals Noninvasive Assessment of Interstitial Fibrosis and Tubular Atrophy in Renal Transplant by Combining Point-Shear Wave Elastography and Estimated Glomerular Filtration Rate

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 18
Author(s):  
Chi Qin ◽  
Hailong Jin ◽  
Haixiang Zhang ◽  
Yun Zhang ◽  
Zhaojie Guan ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Shear Wave ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Interstitial Fibrosis ◽  
Shear Wave Elastography ◽  
Optimal Cutoff ◽  
Tubular Atrophy ◽  
Significant Difference

The purpose of this study was to evaluate the feasibility of the combination of point-shear wave elastography (p-SWE) and estimated glomerular filtration rate (eGFR) for assessing different stages of interstitial fibrosis and tubular atrophy (IF/TA) in patients with chronic renal allograft dysfunction (CAD). From September 2020 to August 2021, 47 patients who underwent renal biopsy and p-SWE examinations were consecutively enrolled in this study. The areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate overall accuracy and to identify the optimal cutoff values for different IF/TA stages. A total of 43 patients were enrolled in this study. The renal cortical stiffness and eGFR showed a significant difference between IF/TA Grade 0–1 and Grade 2–3 (p < 0.001). Additionally, renal stiffness and eGFR were independent predictors for moderate-to-severe IF/TA (Grade ≥ 2) according to multiple logistic regression analysis. The combination of p-SWE and eGFR, with an optimal cutoff value of −1.63, was superior to eGFR alone in assessing moderate-to-severe interstitial fibrosis (AUC, 0.86 vs. 0.72, p = 0.02) or tubular atrophy (AUC, 0.88 vs. 0.74, p = 0.02). There was no difference between p-SWE and eGFR in assessing moderate-to-severe IF/TA (AUC, 0.85 vs. 0.79, p = 0.61). Therefore, combining p-SWE and eGFR is worthy of clinical popularization and application.

ARTIFICIAL NEURAL NETWORKS FOR ESTIMATING GLOMERULAR FILTRATION RATE BY URINARY DIPSTICK FOR TYPE 2 DIABETIC PATIENTS

2016 ◽  
Vol 28 (03) ◽  
pp. 1650016
Author(s):  
Yu Chu-Su ◽  
Chien-Sheng Liu ◽  
Ruey-Shin Chen ◽  
Chii-Wann Lin
Keyword(s):  
Diabetes Mellitus ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Diabetes Mellitus Type 2 ◽  
Filtration Rate ◽  
Optimal Combination ◽  
Diabetes Mellitus Type ◽  
Diabetic Patients ◽  
Test Items

Background: The result of a standard urinary dipstick from a patient with diabetes mellitus type 2 can be used to predict the estimated glomerular filtration rate (eGFR). We designed a multilayer perceptron (MLP) to investigate the possibility and optimal number of variables for the prediction. Methods: A total of 299 volunteers with diabetes mellitus type 2 were included. The blood and urine samples from volunteers were analyzed for blood sugar, glycated hemoglobin, serum creatinine, and urine chemistry. The urine chemistry was examined by a standard urinary dipstick. Volunteer age and gender and six test items of the dipstick were set as eight variables for this study. The eight variables were grouped and examined for the optimal combination. The eight variables from 232 of 299 volunteers were used to train an MLP for the optimal variables. The performance of trained MLP was validated by the data from 69 of 232 volunteers. Results: The optimal combination for variables was the six test items of the dipstick and volunteer age. The area under the curve (0.928), accuracy (0.879), sensitivity (0.83), and specificity (0.88) of the trained MLP were examined. Conclusions: The results demonstrate the eGFR prediction potential of the results of a urinary dipstick using this method.

RELATIONSHIPS BETWEEN HAEMOSTATIC ENDOTHELIAL FUNCTIONS AND GLOMERULAR FILTRATION RATE IN SHORT-TERM TYPE I DIABETES MELLITUS

1987 ◽  
Author(s):  
N Montani ◽  
S B Solerte ◽  
G Gamba ◽  
M Fioravanti ◽  
E Ferrari
Keyword(s):  
Diabetes Mellitus ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Diabetes Duration ◽  
Diabetic Patients ◽  
Type I ◽  
Short Term ◽  
Endothelial Functions ◽  
Term Type

It is known that the increase of glomerular filtration rate (GFR) represents an early sign of diabetic nephropathy. The changes of endothelial functions observed in diabetes might play a role in this respect. As F VIII vWF and fibronectin are synthetized by endothelial cells, we evaluated these components in 33 diabetic patients with short-term Type I (insulin dependent) diabetes mellitus, without retinopathy and macro-vascular complications. 15 pts. (mean age 29 ± 7 yrs; mean diabetes duration 2.9 ± 0.9 yrs) presented high GFR (154 ± 19 ml/min per 1.73 m2 ; albuminuria 7.2 ± 3.2 μg/min) and 18 pts. (mean age 30 ± 6 yrs; mean diabetes duration 3.0 ± 1 yrs) normal GFR (105 ± 11 ml/min per 1.73 m2 ; albuminuria 5 ± 2.8 μg/min).The following results were obtained:In conclusion the significant increase of FVIIIR:Ag and fibronectin levels in short-time type I diabetic patients with high GFR suggests an early endothelial cell function damage also related to the Door metabolic control.

scholarly journals P1038NEPHROPROTECTIVE EFFECT OF SGLT2 INHIBITORS DURING FIRST YEAR OF TREATMENT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Catarina Almeida ◽  
Leonor Silva ◽  
Tiago Costa ◽  
Daniela Lopes ◽  
Luís Andrade
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Glucose Control ◽  
Filtration Rate ◽  
Sglt2 Inhibitors ◽  
Oral Drug ◽  
First Year ◽  
Diabetic Patients ◽  
Control Therapy ◽  
One Year

Abstract Background and Aims SGLT2 inhibitors, the most recent glucose-lowering oral agents, have the potential to exert nephroprotection not only through improving glycemic control but also through glucose-independent effects. Recent studies demonstrate this effect with decreased albuminuria and lowering the progression of chronic kidney disease. The aim of our study was to evaluate the effect of iSGLT2 on glomerular filtration rate and albuminuria during the first year of treatment. Method This was a retrospective cross-sectional study that included patients diagnosed with DM2 and treated with an iSGLT2 during 1 year in a Diabetic Clinic. Demographic and clinical variables were collected, including HbA1c, disease duration and cardiovascular risk factors (CVRF). Patient glucose-control therapy as well as RAAS inhibitor drugs were gathered. The estimated Glomerular Filtration Rate (eGFR) by the formula CKD-EPI and albuminuria, using the urinary albumin-to-creatinine ratio, were evaluated at the iSGLT2 introduction date and at 3, 6, 9 and 12 months of treatment. Results We analyzed 208 patients, 53.8% male, mean age 65.5 years, median baseline HbA1c 8.4% and median duration of DM2 14 years. Of all patients, 94.2% had at least 1 CVRF, 71.6% were hypertensive, 83.2% had dyslipidemia, 48.1% were obese, and 25.2% had past/current smoking habits. Regarding glucose-control therapy, only 20.2% were treated with one oral drug class and the remaining with 2 or more classes, with 81.7% of the patients receiving metformin and 51.4% being on insulin therapy. Overall, 63.5% of patients received dapaglifozin therapy and 36.5% empaglifozin. Also, 56.3% were on a RAAS inhibitor. Regarding eGFR, 15.6% patients had an eGFR between 30 and 60 and 84.4% patients had an eGFR greater than 60 ml/min/1.73m2. As for albuminuria, 37 patients had normal albuminuria (&lt;30mg/g), 18 patients had moderate albuminuria (30-300mg/g) and 6 patients had severe albuminuria (&gt;300mg/g). In 12 months, there was a significant reduction in HbA1c (mean variation 0.5%) (p&lt;0.001). Evaluating eGFR throughout the year, a decrease was observed in the first 6 months from an average of 81.6 to 78.5 ml/min/1.73m2 (p=0,001). Although on the second semester, there was an increase in eGFR to 83.4 ml/min/1.73m2 (p&lt;0.001). These were similar in patints treated with dapagliflozin and empagliflozin. In patients with eGFR &lt;60ml/min at the admission, there was an increase in eGFR from 49.6 to 53.4ml/min/1.73m2 after one year of treatment (p=0,260). A decrease in albuminuria levels was observed in the first year of iSGLT2 use, either in the case of moderate albuminuria (initial median of 80.52mg/g to 54.88mg/g) (p=0,758) or severe albuminuria (initial mean 650.40mg/g to 420.28mg/g) (p=0,213). Conclusion This data shows that after an initial reduction in eGFR during the first 6 months of treatment, the use of iSGLT2 after one year improved the eGFR, promoting a nephroprotective effect in type 2 diabetic patients.

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