Characterization of Diabetic Kidney Disease in 235 Patients: Clinical and Pathological Insights with or without Nondiabetic Kidney Disease

Background: Diabetic kidney involvement primarily manifests as diabetic kidney disease (DKD). However, some diabetic patients may solely present with diabetes mellitus or non-diabetic kidney disease (NDKD), or DKD combined with NDRD. This study statistically analyzed patients with DKD alone and DKD+NDKD, investigating their pathological and clinical characteristics, and identifying the independent factors associated with DKD+NDKD to aid clinical differentiation. Methods: A retrospective analysis of 235 patients admitted to the Department of Nephrology at Hangzhou Hospital of Traditional Chinese Medicine was conducted between 2014-7 and 2022-12. These patients underwent renal biopsy and received a pathology-based diagnosis of DKD. They were categorized into the DKD alone group (93 cases) and the DKD+NDKD group (142 cases).DKD pathology grading criteria published in the American Journal of Kidney Diseases were used as a reference for grading. Results: In the DKD alone group, gender distribution was even, with ages mainly between 50-59 years, and a disease duration of less than 5 years, primarily presenting nodular diabetic glomerulosclerosis. In contrast, the DKD+NDKD group had a higher male incidence, a wider age range, longer disease duration, and prevalent diffuse diabetic glomerulosclerosis. Acute and chronic tubulointerstitial lesions and IgA nephropathy were the predominant types of combined NDKD, accounting for 40.14% and 35.21%, respectively. Clinical correlation analysis revealed associations between glomerular grading, tubulointerstitial lesions, renal arteriolar vitelliform lesions, renal vascular atherosclerosis, and clinical parameters such as 24-hour urine protein, hemoglobin, and urinary specific gravity. Multifactorial logistic regression analysis identified independent factors affecting DKD+NDKD, including body mass index, serum creatinine (Scr), microscopic erythrocyte grade, urinary immunoglobulin G (IgG)/creatinine ratio, and serum immunoglobulin A (IgA). Conclusion: Our research underscores distinctions in age, gender distribution, disease duration, and renal pathology between DKD alone and DKD+NDKD groups. Additionally, significant discriminative factors including BMI, Scr, microscopic erythrocyte grade, UIgG/urine creatinine ratio, and serum IgA levels help differentiate DKD from NDKD, thereby enabling personalized treatment approaches.