#3377 Not everything is diabetic nephropathy. Analysis of kidney biopsies in type 2 diabetic patients on a 15-year-old cohort

Abstract Background and Aims There are predictive models that guide the performance of renal biopsy in diabetic patients in whom there is no clear relationship between kidney pathology and diabetes mellitus. The García-Martín score assigns a score based on the presence or absence of diabetic retinopathy, chronic ischemia in the lower limbs, overweight, insulin dependence, nephrotic proteinuria and microhematuria. A value less than −0.5 is suggestive of non-diabetic kidney disease (NDKD) and greater than 3 is suggestive of diabetic kidney disease (DKD). We analyze this score in our cohort. Method Retrospective descriptive study of the clinical-histological findings in all patients with type 2 diabetes mellitus biopsied between 2008 and 2023 in our hospital. Results Of the 427 biopsies, 80 were from type 2 diabetic patients, whose characteristics Demographics and clinical-histological results are shown in Fig. 1. The entire cohort presented significant renal dysfunction, median creatinine of 1.9 mg/dl (IQR, 0.8–11) in the time of kidney biopsy. Proteinuria measured by protein/creatinine ratio was 2700 mg/g (32–7000) and 50% presented microhematuria. All of patients (n:36) with a score less than 1 point (−4 to 0.5) were NDKD, among which the membranous nephropathy, nephroangiosclerosis and IgA nephropathy. Of the patients with a score greater than or equal to 1 point (n:44), there was only one patient with NDKD, all of whom the rest DKD (n:43) with a Score range between 1 and 3.5 points. Unlike other studies, in our cohort diabetic retinopathy did not predict the presence of DKD (P > 0.88). The histological lesions had greater glomerular involvement, interstitial and vascular in DKD versus NDKD and a high percentage progressed to advanced kidney disease (15%) or initiation of renal replacement therapy (20%). Conclusion In our cohort a score less than 1 point had a high specificity for NDKD with a negative predictive value of 100%. Therefore, it reinforces the indication of a kidney biopsy in this group of patients.