Plasma homocysteine is associated with nonproliferative retinopathy in patients with type 2 diabetes without renal disease

Diabetic nephropathy is a well known complication of diabetes mellitus and the leader cause of end -stage renal disease worldwide. Nonetheless, other forms of renal involvement can occur in diabetic population. Since it has prognostic and therapeutic implications, differentiating non-diabetic renal disease from diabetic nephropathy is of great importance. We report an 80-year-old man with well-controlled type 2 diabetes mellitus and hypertension, who presented with rapid deterioration of renal function, nephrotic proteinuria, microscopic hematuria and leukocyturia. The atypical clinical presentation prompted us to perform a kidney biopsy. A diagnosis of proliferative glomerulonephritis with monoclonal immunoglobulin deposits (light chain only variant) was made, with however some chronic histological aspects which made us took a conservative therapeutic attitude. We emphasize that other causes of chronic proteinuric kidney disease should be considered in patients with type 2 diabetes mellitus, based on clinical suspicion, absence of other organ damage and mostly if an atypical presentation is seen. We review the spectrum of monoclonal gammopathies of renal significance, focusing on this rare and newly describe entity.

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The Severity of Diabetic Retinopathy Is an Independent Factor for the Progression of Diabetic Nephropathy

Journal of Clinical Medicine ◽

10.3390/jcm10010003 ◽

2020 ◽

Vol 10 (1) ◽

pp. 3

Author(s):

Shi-Chue Hsing ◽

Chia-Cheng Lee ◽

Chin Lin ◽

Jiann-Torng Chen ◽

Yi-Hao Chen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

Kidney Disease ◽

Renal Disease ◽

Disease Progression ◽

Renal Disease Progression ◽

Hazard Ratios ◽

Stage Renal Disease ◽

End Stage

(1) Background: It has rarely been studied whether the severity of diabetic retinopathy (DR) could influence renal disease progression in end-stage renal disease (ESRD) and chronic kidney disease (CKD) in patients with type 2 diabetes. The aim of this study was to evaluate renal disease progression in ESRD and CKD according to DR severity in patients with type 2 diabetes. (2) Methods: We included 1329 patients and divided the cohort into two end-points. The first was to trace the incidence of ESRD in all enrolled participants and the other was to follow their progression to CKD. (3) Results: Significantly higher crude hazard ratios (HRs) of ESRD incidence in all enrolled participants were noted, and this ratio increased in a stepwise fashion. However, after adjustment, DR severity was not associated with ESRD events. Therefore, a subgroup of 841 patients without CKD was enrolled to track their progression to CKD. Compared with no diabetic retinopathy, the progression of CKD increased in a stepwise fashion, from mild nonproliferative diabetic retinopathy (NPDR) to moderate NPDR, to severe NPDR and to proliferative diabetic retinopathy (PDR), both in the crude and adjusted models. (4) Conclusions: The severity of retinopathy appeared to be associated with renal lesions and the development of CKD. Our findings suggest that the severity of DR is a risk factor for progression to CKD. Therefore, diabetic retinopathy is useful for prognosticating the clinical course of diabetic kidney disease.

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African-Caribbean ethnicity and HbA1c variability are associated with rapid non-linear renal function decline in patients with type 2 diabetes who reach end-stage renal disease

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2021.107875 ◽

2021 ◽

pp. 107875

Author(s):

Stanimir I. Stoilov ◽

Nikolaos Fountoulakis ◽

Angeliki Panagiotou ◽

Stephen Thomas ◽

Janaka Karalliedde

Keyword(s):

Type 2 Diabetes ◽

Renal Function ◽

Renal Disease ◽

End Stage Renal Disease ◽

Renal Function Decline ◽

African Caribbean ◽

Stage Renal Disease ◽

End Stage ◽

Hba1c Variability

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Lifetime risk of cardiovascular-renal disease in type 2 diabetes: a population-based study in 473399 individuals

European Heart Journal ◽

10.1093/ehjci/ehaa946.3313 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Zhang ◽

J Mamza ◽

T Morris ◽

G Godfrey ◽

F Asselbergs ◽

...

Keyword(s):

Type 2 Diabetes ◽

Renal Disease ◽

Population Based ◽

Lifetime Risk ◽

Disease Stage ◽

Renal Diseases ◽

Funding Source ◽

Private Company ◽

Risk Of Death

Abstract Background Lifetime risks of cardiovascular (CV) and renal diseases are high, particularly in type 2 diabetes (T2D), but rarely studied together, and relative disease contributions are unknown. Knowledge of lifetime risk of cardiovascular-renal disease (CVRD) will better reflect disease burden in T2D. Purpose To investigate the lifetime risks (LTRs) of composite and individual components of major adverse reno-cardiovascular events, MARCE in T2D patients. Method In a population-based cohort study using national electronic health records, we studied 473399 individuals aged 45–99 years with T2D in England 2007–2018. The LTR of composite and individual components of MARCE (including CV death and CVRD: heart failure, HF; chronic kidney disease stage 3 and above, CKD; myocardial infarction, MI; stroke or peripheral artery disease, PAD) were estimated. LTRs by baseline CVRD comorbidity status were compared with individuals free from CVRD at baseline, accounting for the competing risk of death. Results Among T2D patients aged ≥45 years, the LTR of MARCE was 80% for individuals free from CVRD at baseline. LTR of MARCE was 97%, 93%, 98%, 89% and 91% for individuals with specific CVRD comorbidities for HF, CKD, MI, stroke and PAD, respectively at baseline. Within the CVRD-free cohort, LTR of CKD was highest at 54%, followed by CV death (41%), HF (29%), stroke (20%), MI (19%) and PAD (9%). Compared to CVRD-free, HF, MI and CKD at baseline were associated with the highest LTR of MARCE and its component diseases (Table). Conclusion The lifetime risk of CV disease and CKD in T2D patients is estimated to be over 60% and 50% respectively (1–3). When considered together, the LTR of MARCE is 80% in CVRD-free T2D patients, while nearly all those with T2D and HF will develop MARCE over their lifetime. Of the individual components of MARCE, LTR of CKD and HF were the highest among CVRD-free T2D patients. Preventive measures in T2D patients should be a priority in clinical practice to mitigate the burden of these complications. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): AstraZeneca

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