Histological evidences of diabetic kidney disease precede clinical diagnosis

Abstract

In the absence of a histhological diagnosis, persistent albuminuria is globally accepted as the main diagnostic criteria for diabetic kidney disease.\n\nIn the present retrospective study, we evaluated data from an Italian cohort of 42 diabetic deceased donors (mainly type 2 diabetes). Using kidney biopsies obtained at time of donation to evaluate single or double allocation based on Karpinski score, we determined the prevalence of histological lesions attributable to diabetes.\n\nAll 42 donors presented with normoalbuminuria and an estimated Glomerular Filtration Rate (CKD-EPI) > 60 ml/min/1.73m2. Of the 36 patients with available kidney biopsy, one was non interpretable and 32 had histopathological lesions consistent with diabetic kidney disease and encompassing all histological classes.\n\nThus, we found a relatively high proportion of histologically proven diabetic kidney disease that was clinically undiagnosed as none of the patient had significant albuminuria and eGFR <60 cc/min/1.73 m2. Our data support the need to implement routine kidney biopsies in normoalbuminuric diabetic subjects in early stages of Chronic Kidney Disease. As others have shown that histological lesions associated with diabetic kidney disease predict disease progression, such strategy may help to risk stratify patients and may guide therapeutic decisions at early disease stages.