Nondiabetic Renal Pathology in Biopsies of Type 2 Diabetes Mellitus Patients: Changing Trends and the Clinical Factors Predicting These Lesions

The underlying histopathology of diabetic kidney disease is classically described as diabetic glomerulosclerosis (DGS). Over the years, it has been noted that kidney biopsies in type 2 diabetes mellitus (T2DM) patients are revealing lesions other than DGS because of the changing natural history of diabetic kidney disease. A retrospective study of all kidney biopsies in T2DM patients over a three-year period submitted to the Pathology Departments of Apollo Hospitals, Hyderabad, and Yashoda Hospitals, Secunderabad, India, was analyzed. The clinical data were analyzed for the type of biopsy lesions and the clinical predictors of nondiabetic renal pathology in these biopsies. The result of this study was compared with another study published by one of the authors in 2006. A total of 1029 biopsies were obtained from the records. Pure DGS was seen in 341 (33.1%) and nondiabetic renal lesions were seen in 482 (46.8%) biopsies. The most common histological lesion in the isolated nondiabetic renal disease group was interstitial nephritis (acute and chronic). Incidence of minimal change disease and membranous nephropathy is significantly less in the current cohort. The factors which were predictive of isolated nondiabetic lesions were short duration of diabetes and renal failure (unexplained/rapid deterioration). 66.9% of biopsies show nondiabetic-renal lesion histopathology in T2DM patients. This offers the clinician an opportunity to consider specific treatment wherever possible.