L SKEAT1, S DHEDA1,2, T SIU1, M MANTHA1
1Cairns Base Hospital, Cairns, Australia, 2James Cook University,
Aim: To determine if clinical characteristics may predict non-diabetic histopathology in diabetics in Far North Queensland (FNQ)
Background: In Australia, FNQ has a disproportionately high prevalence of type 2 diabetes (T2DM) and a high prevalent Indigenous population. Renal biopsy in diabetics is usually not undertaken unless the clinical presentation is atypical. However, our local data suggest that non-diabetic kidney disease (NDKD) is highly prevalent in the diabetic population. Previous studies have found that optimal glycaemic control and absence of microvascular diabetic complications (retinopathy and neuropathy) can be predictive of NDKD. We sought to explore the prevalence and predictors of NDKD in our local diabetic population.
Methods: A retrospective analysis of the clinical, laboratory and histopathological data was undertaken. We confirmed 163 diabetics who underwent renal biopsy between 1993 and 2016 at Cairns Base Hospital. Histology was quantified as either DKD, mixed or NDKD. Demographic data, presence of microvascular disease and comorbidities was quantified. A multivariate logistic regression model was used to ascertain significant correlates for NDKD.
Results: The prevalence of DKD, NDKD and mixed pathology amongst the 163 biopsies were 48.5%, 26.4% and 25.2 respectively. The presence of microvascular diabetic complication did predict DM histology (odds ratio (OR) = 4.37 (95% CI = 1.25-15.3, p = 0.021). Estimated GFR (p= 0.33), HbA1C (p=0.27) and haematuria (p=0.45) did not predict the presence of DKD.
Conclusion: Clinical differentiation between DKD and NDKD in a diabetic population is challenging and cases of NDKD that are treatable may be missed due to lack of renal biopsy. This study demonstrates that, in DM patients, the presence of microvascular complications, is associated with traditional DKD pathology.
Dr Lee Skeat is a current trainee in nephrology based in Melbourne who completed training time at Cairns Base Hospital in FNQ.