A clinicopathological study of 36 diabetic patients with proteinuria

Background: About one-fourth to one-third of diabetic patients develop renal manifestations. The commonest renal manifestation of a diabetic patient is proteinuria. Besides, patients may also present with chronic renal failure and hematuria with or without dysmorphic RBC. Renal manifestation in all proteinuric diabetic patients may not be due to diabetic nephropathy but also non-diabetic renal disease (NDRD). For diabetic patients, distinguishing non-diabetic renal disease (NDRD) from diabetic nephropathy (DN) is important in choosing treatment modalities and determining renal prognosis. 
Aim of Study: To see the clinic-pathological manifestation of diabetic patients with proteinuria. among diabetic patients. The duration of diabetes in NDRD is significantly shorter than that in DN. 
Methodology: A total of 36 Diabetic patients with nephrotic/nonnephritic range proteinuria, with or without dysmorphic RBC were enrolled in this study. Two biopsies from each patient were obtained by percutaneous needle biopsy by experienced nephrologists after explaining the procedure to the patients and obtaining their written consent. The tissue in normal saline was frozen for subsequent cryostat sectioning and stained with fluorescein isothiocyanate (FITC) conjugated antibodies against immunoglobulin (IgG, IgA, IgM), Complement component (C3, C1q), and Fibrinogen. 
Result: Most of the patients showed non-diabetic kidney disease (63.0%) vs diabetic nephropathy (37%) on diagnosis. Most of the patients with dysmorphic RBC showed non-diabetic kidney disease in 12 (60.0%) and eight (40.0%) as diabetic nephropathies on final diagnosis. Regarding the prognosis of diabetic nephropathy, about 25% of patients will develop into end-stage renal failure within 6 years and 50 % within 10 years. 
Conclusion: To conclude, clinical parameters such as short duration of diabetes, non-nephrotic range proteinuria, hematuria, and acanthocytes or dysmorphic RBCs may be used as a clinical marker for non-diabetic kidney diseases among diabetic patients. Early diagnosis of NDRD poses a favorable renal prognosis because it requires a different approach than DN.