Non-Classical Clinical Types and Pathological Changes of Diabetic Kidney Disease:A Review
- VernacularTitle:糖尿病肾脏疾病非经典临床类型与病理变化综述
- Author:
Chenxi FANG
1
;
Liya SUN
;
Yan LIU
;
Li XIAO
;
Lin SUN
Author Information
- Keywords: Diabetic kidney disease; Albuminuria remission; Normoalbuminuria; Rapid decline in renal function; Crescent; Review
- From: Journal of Sichuan University (Medical Sciences) 2023;54(6):1074-1079
- CountryChina
- Language:Chinese
- Abstract: Diabetic kidney disease(DKD)is a common complication of diabetes mellitus and approximately 1/3 of diabetic patients may progress to DKD.A typical early clinical manifestation of DKD is microalbuminuria and patients may present with macroproteinuria accompanied by a decrease in renal function condition as the disease progresses.It is generally believed that the likelihood of a reversal of the disease is reduced after the development of macroproteinuria in patients with DKD,and that eventually some patients' condition may develop into end-stage renal disease(ESRD).Moreover,the thickening of the glomerular basement membrane,mesangial matrix expansion,Kimmelstiel-Wilson (K-W)nodules,and glomerulosclerosis in end-stage diabetes mellitus are typical pathologic changes of DKD.However,some DKD patients,especially those with type 2 diabetes mellitus(T2DM)combined with chronic kidney disease,may have diverse clinical manifestations,showing variations in disease progression and regression,and manifesting as non-classical types of DKD,such as normoalbuminuric DKD,proteinuria-reduced DKD,and DKD with rapid decline in renal function.In addition,the formation of crescents,a special pathological change,is observed in renal biopsy.However,this issue is currently under-recognized by clinicians and therefore deserves more attention.In order to improve clinicians' understanding of the presentations and pathological changes of non-classical DKD and the level of DKD prevention and treatment in China,we present a preliminary introduction to the clinical phenotypes and pathological changes of non-classical types of DKD in this paper by summarizing the findings of our prior studies as well as domestic and international literature.
