Clinicopathological Spectrum of Biopsy Proven Kidney Disease in Diabetics

Background Diabetes mellitus is the leading cause of chronic kidney disease worldwide. Nephrologists might miss nondiabetic kidney diseases (NDKD) because they might avoid biopsies due to the presumption of diabetic kidney disease (DKD). This study retrospectively analyzed kidney biopsies of patients with diabetes in a large Indian multi-super specialty tertiary care private hospital. Materials and Methods Case records of 130 diabetic patients who underwent kidney biopsies at the institute between January 2013 and December 2022 were included. Results The mean age was 56 ± 9.7 years. There were 102 (78.4%) males; 79 (60.79%) had NDKD, 34 (26.15%) had DKD, and 17 (13.07%) had combined disease. Diabetic retinopathy was more common in those with DKD (58.5%) than NDKD (8.8%) ( p =<0.001). The mean duration of diabetes in NDKD was 7.92 ± 4.14 years, compared to 9.44 ± 5.51 and 9.77 ± 5.54 years in those with DKD and combined disease, respectively ( p =0.27). Nephrotic syndrome was most common, followed by rapidly progressive renal failure and acute kidney injury. The most common glomerular disease with NDKD, diagnosed by kidney biopsy, was membranous nephropathy (13.92%), followed by IgA Nephropathy (12.66%), and focal segmental glomerulosclerosis (8.86%). Conclusion NDKD was seen in most patients with diabetes who underwent a kidney biopsy. For patients with diabetes presenting atypical features, a low threshold for kidney biopsy might change the management and outcomes.