GLOMERULONEPHRITIS IN GLOMERULONEPHRITIS IN TYPE 2 DIABETES TYPE 2 DIABETES

MELLITUSMELLITUS MOHAN DAS M.K,MOHAN DAS M.K,

JACOB GEORGE,VIMALA.A.JACOB GEORGE,VIMALA.A.

DEPARTMENT OF NEPHROLOGY,DEPARTMENT OF NEPHROLOGY,MEDICAL COLLEGE,MEDICAL COLLEGE,

THIRUVANANTHAPURAMTHIRUVANANTHAPURAM

1

BACKGROUNDBACKGROUND

• INCREASING INCIDENCE OF NON DIABETIC RENAL DISEASE AS A CAUSE OF ACUTE RENAL FAILURE IN TYPE 2 DIABETES MELLITUS.

• SPECIFIC TREATMENT ALTERS OUTCOME.

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OBJECTIVESOBJECTIVES

• INCIDENCE AND CLINICAL PROFILE OF NON DIABETIC RENAL DISEASE IN TYPE 2 DIABETES MELLITUS

• RENAL HISTOLOGY

• IDENTIFY NATURE OF GLOMERULAR DISEASE

• PROGNOSTIC FACTORS

• RESPONSE TO SPECIFIC TREATMENT

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PATIENTS&METHODSPATIENTS&METHODS

• PERIOD OF STUDY JUNE 1,2001-DEC 31,2004INCLUSION CRITERIA• PATIENTS WITH TYPE 2 DIABETES MELLITUS

AND ANY ONE OF THE FOLLOWING 1. ANTECEDENT INFECTION.2. MICROSCOPIC OR MACROSCOPIC

HAEMATURIA WITH NEGATIVE URINE CULTURE.

3. DISPROPORTIONATE DECLINE IN GFR.4. .LOW C3.5. ABSENCE OF DIABETIC RETINOPATHY.

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PATIENTS&METHODSPATIENTS&METHODS(CONT.)(CONT.)

• GFR IS CALCULATED USING COCKROFT AND GAULT FORMULA

• DISPROPOTIONATE DECLINE IN GFR DEFINED AS DECREASE IN GFR MORE THAN 10ml/year

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EXCLUSION CRITERIAEXCLUSION CRITERIA

1. PATIENTS WITH CARDIAC FAILURE.

2. PATIENTS WITH ISCHAEMIC NEPHROPATHY.

3. IDENTIFIED PRECIPITATING FACTORS FOR DETERIORATION OF GFR LIKE DRUGS, HYPOVOLEMIA.

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RESULTSRESULTS

• TOTAL NUMBER OF PATIENTS -24• MEAN AGE OF PRESENTATION-51• MALE TO FEMALE RATIO -13:11• MEAN DURATION OF DIABETES-8yrs• MEAN DURATION OF HYPERTENSION-5yrs• MEAN BLOOD PRESSURE -150/100mmHg• ALL PATIENTS HAD NON NEPHROTIC RANGE

PROTEINURIA WITH A MAXIMUM OF 2.8gms.

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CLINICAL PROFILE OF POST CLINICAL PROFILE OF POST INFECTIOUS CRESCENTIC GNINFECTIOUS CRESCENTIC GN

Mean age 51.6

M : F 4:1

Mean MAP 103

Mean duration of DM 10

Oliguria 100%

Pyoderma 100%

Low C3 3/5

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CLINICAL PROFILE OF POST CLINICAL PROFILE OF POST INFECTIOUS CRESCENTIC GNINFECTIOUS CRESCENTIC GN

Dialysis requiring RF 100%

Underlying diabetic nephropathy 100%

TIN 2/5

Type of crescents Cellular 2

Fibrocellular 3

Mortality 100%

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Character Survived Death

Mean age 53.6 57.3

M : F 2:1 2:1

Mean MAP 95.6% 99.6%

Mean duration of DM 10 16

Oliguria 100% 100%

Pyoderma 66% 100%

Low C3 1/1 1/1

CLINICAL PROFILE OF DPGN CLINICAL PROFILE OF DPGN WITHOUT CRESCENTSWITHOUT CRESCENTS

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CLINICAL PROFILE OF DPGN CLINICAL PROFILE OF DPGN WITHOUT CRESCENTSWITHOUT CRESCENTS

Dialysis requiring

RF

66.6% 100%

Underlying diabetic

nephropathy

1/3 3/3

TIN 33% 33%

Mean Serum

Creatinine

3.8 7.1

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Mean age 48.6

M : F 1:2

Mean MAP 97.6%

Mean duration of DM 4.3

Oliguria 66.6%

Pyoderma 66.6%

Dialysis requiring RF 66.6%

CLINICAL PROFILE OF IgACLINICAL PROFILE OF IgA

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CLINICAL PROFILE OF IgACLINICAL PROFILE OF IgA

Underlying diabetic nephropathy 1/3

TIN 33%

Mean Serum Creatinine 6

Crescents 1/3

Total No. of Patients 3/24

Survival 100%

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CLINICAL PROFILE OF CLINICAL PROFILE OF MGN, MPGN AND LNMGN, MPGN AND LN

Character MGN (2/18) MPGN (1/18) LN(1/18)

Mean age 55 73 41

M : F 2:0 1:0 1:0

Mean MAP 91.5 106 103

Mean duration

of DM

2.5 2 8

Oliguria 100% 100% 100%

Dialysis

requiring RF

1/2 0 0

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CLINICAL PROFILE OF CLINICAL PROFILE OF MGN, MPGN AND LNMGN, MPGN AND LN

Character MGN (2/18) MPGN (1/18) LN(1/18)

Underlying

diabetic

nephropathy

1/2 1/1 0/1

TIN NIL 1/1 0/1

Mean Serum

Creatinine

4.3 1.4 2.3

Crescents ½ 0/1 0/1

Survival 100% 100% 100%

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CLINICAL PROFILE OF PATIENTS CLINICAL PROFILE OF PATIENTS WITH DN ALONEWITH DN ALONE

Character Survived Death

Mean age 47 43

M : F 1:1 0:2

Mean MAP 101.6 105

Mean Duration of DM 6.2 4.5

Oliguria 100% 100%

Dialysis requiring RF 0% 100%

TIN 33% 33%

Mean Serum

Creatinine

3 5

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CLINICAL PROFILE OF PATIENTS CLINICAL PROFILE OF PATIENTS WITH TIN AND TIN+DNWITH TIN AND TIN+DN

Character TIN (1/24) TIN+DN (1/24)

Mean age 46 47

M : F 1:0 0:1

Mean MAP 91 92

Mean Duration of DM 4 8

Oliguria 0% 100%

Dialysis requiring RF 0% 100%

Mean Serum Creatinine 2.7 12

Survival 100% 0%

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STATISTICAL ANALYSIS-STATISTICAL ANALYSIS-GN IN TYPE 2 DMGN IN TYPE 2 DM

• Mean value for oliguria and pyoderma in survived group was 0.615 and 0.538 respectively and in expired group 1.00 and 1.00

• Standard error was 0.14 and 0.143 in survived group and 0.00 and 0.00 in expired group.

• p-value was 0.018 and 0.008 in survived group and 0.02 and 0.008 in expired group

• Statistically significant.

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GN IN TYPE 2 DIABETES GN IN TYPE 2 DIABETES MELLITUSMELLITUS

VariablesGroup Code No Mean

Std. Error Mean p.value

Duration of DM 1 2 11 13 10.727 7.0769 2.33 1.51 0.191 0.207

MAP 1 2 11 13 104.83 100.75 2.07 2.27 0.205 0.198

Duration of HTN 1 2 11 13 5.54 3.92 1.39 1.15 0.375 0.38

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GN IN TYPE 2 DIABETES GN IN TYPE 2 DIABETES MELLITUSMELLITUS

VariablesGroup

Code No MeanStd. Error

Mean p.value

24 hr Urine Protein

1 2 11 13 1229.1 1215.8 124.8 216.3 0.96 0.958

Oliguria 1 2 11 13 1 0.615 0 0.14 0.02 0.018

Pyoderma 1 2 11 13 1 0.5385 0 0.143 0.008 0.008

Serum Creatinine

1 2 11 13 6.37 4.007 0.656 0.354 0.003 0.00647

STATISTICAL ANALYSIS - STATISTICAL ANALYSIS - DPGN IN TYPE 2 DMDPGN IN TYPE 2 DM

• No variables are found to be statistically significant.

• May be because of small sample size.

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DPGN IN TYPE 2 DMDPGN IN TYPE 2 DM

VariablesGroup Code

No. MeanStd. Error

Meanp. value

Age 1 2 8 3 53.75 53.66 3.266 3.48 0.989 0.987

Duration of DM 1 2 8 3 12.62 10 2.94 3.6 0.636 0.598

MAP 1 2 8 3 105.81 108.86 2.79 5.56 0.601 0.657

Duration of HTN

1 2 8 3 7 5.33 1.62 2.33 0.596 0.588

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DPGN IN TYPE 2 DMDPGN IN TYPE 2 DM

VariablesGroup

CodeNo Mean

Std. Error Mean

p. value

24 hr Urine Protein

1 2 8 3 1140 726.66 161.2 136.7 0.178 0.089

Pyoderma 1 2 8 3 1 0.666 0 0.333 0.104 0.423

Serum Creatinine

1 2 8 3 6.125 4.6 0.3895 0.665 0.07 0.13

Dialysis requiring renal failure

1 2 8 3 1 0.333 0 0.333 0.006 0.184

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