Clinical and pathological characteristic analysis of diabetic kidney disease with Kimmelstiel-Wilson nodule
10.3760/cma.j.cn115455-20240710-00592
- VernacularTitle:伴有Kimmelstiel-Wilson结节糖尿病肾脏疾病患者的临床病理特征分析
- Author:
Kai CHEN
1
;
Yingying WANG
;
Xianmin BU
;
Huijuan MA
Author Information
1. 济宁市第一人民医院肾内科，济宁 272011
- Publication Type:Journal Article
- Keywords:
Diabetic nephropathies;
Pathological change;
Kimmelstiel-Wilson nodules
- From:
Chinese Journal of Postgraduates of Medicine
2025;48(5):434-439
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the correlation between Kimmelstiel-Wilson nodule (KW nodule) and clinical indexes in patients with diabetic kidney disease (DKD), and analyze the efficacy of the clinical indexes in evaluating KW nodule.Methods:The clinical data of 60 patients with DKD from January 2015 to February 2024 in Jining First People′s Hospital were retrospectively analyzed. Among them, 35 patients had KW nodule (KW nodule group), and 25 patients did have KW nodule (non-KW nodule group). The clinical indexes, including hematological (creatinine, uric acid, urea nitrogen, globulin, albumin, glycosylated hemoglobin and hemoglobin) and urine routine (24 h urinary protein quantification, urinary red blood cell count and urinary white blood cell count) were recorded; the estimated glomerular filtration rate (eGFR) was calculated. Spearman correlation was used to analyze the correlation between clinical indexes and KW nodule. Multivariate Logistic regression was used to analyze the independent risk factors for KW nodule in patients with DKD. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of clinical indexes in evaluating KW nodule.Results:The creatinine, urea nitrogen, 24 h urinary protein quantification and urine red blood cell count in KW nodule group were significantly higher than those in non-KW nodule group: 114 (89, 156) μmol/L vs. 70 (59, 87) μmol/L, 9.00 (6.90, 11.43) mmol/L vs. 5.10 (4.52, 7.55) mmol/L, 4.56 (2.36, 7.23) g vs. 1.40 (1.11, 1.97) g and (19.24 ± 12.64)×10 6/L vs. (9.24 ± 8.67)×10 6/L, the eGFR, albumin and hemoglobin were significantly lower than those in non-KW nodule group: (60.82 ± 28.16) ml/(min·1.73 m 2) vs. (98.34 ± 30.16) ml/(min·1.73 m 2), (30.21 ± 6.64) g/L vs. (39.89 ± 6.49) g/L and (107.54 ± 17.28) g/L vs. (136.87 ± 22.90) g/L, and there were statistical differences ( P<0.01); there were no statistical differences in uric acid, globulin, glycosylated hemoglobin and urinary white blood cell count between the two groups ( P>0.05). Spearman correlation analysis result showed that creatinine, urea nitrogen, 24 h urinary protein quantification and urine red blood cell count were positively correlated with KW nodule ( r = 0.471, 0.559, 0.510 and 0.411; P<0.01); the eGFR, albumin and hemoglobin were negatively correlated with KW nodule ( r = - 0.607, - 0.590 and - 0.600; P<0.01). Multivariate Logistic regression analysis result showed that high 24 h urinary protein quantification and low albumin were independent risk factors for KW nodule in patients with DKD ( OR = 3.415 and 0.829, 95% CI 1.002 to 8.956 and 0.690 to 0.995, P<0.05). ROC curve analysis result showed that the areas under the curve of eGFR, hemoglobin, albumin, creatinine, 24 h urinary protein quantification and urine red blood cell count for KW nodule in patients with DKD were 0.852, 0.840, 0.848, 0.836, 0.881 and 0.768, respectively; the optimal cut-off values were 69.00 ml/(min·1.73 m 2), 110.00 g/L, 31.75 g/L, 96.10 μmol/L, 2.60 g and 15.52 × 10 6/L. Conclusions:There is a good correlation between KW nodule and the clinical features of DKD patients. Decreased renal function, anemia, proteinuria and hypoproteinemia have strong suggestive effects on KW nodule. Especially, proteinuria is more closely related.
