Introduction: This study evaluated the clinicopathological profiles and prognostic trajectories of non-diabetic renal disease (NDRD) subtypes coexisting with type 2 diabetes mellitus (T2D). Methods: The study cohort comprised of 123 patients with predominant NDRD subtypes: IgA nephropathy (T2D-IgAN, n=52), membranous nephropathy (T2D-MN, n=48), and podocytopathies (T2D-Podo, n=23). Multivariate Cox regression was used to identify prognostic factors for renal outcomes over a median follow-up period of 80 months (interquartile range IQR 62-102). Results: T2D-MN patients exhibited distinct characteristics compared to T2D-IgAN and T2D-Podo, including advanced age, higher incidence of nephrotic-range proteinuria and elevated total cholesterol. This group also demonstrated a greater susceptibility to atherosclerotic plaque formation. Pathological analysis revealed more severe glomerular sclerosis, interstitial inflammation, and C3 deposition in T2D-IgAN. Multivariate Cox regression identified three independent predictors of renal endpoints: glomerular C3 deposition (HR 3.021, 95%CI 1.084-8.419), preserved estimated glomerular filtration rate (eGFR) (>60 ml/min/1.73 m²; HR 0.296, 95%CI 0.110-0.796), and prolonged T2D duration (>10 years; HR 4.168, 95%CI 1.389-12.503). Conclusion: These findings suggest that integrating clinical and pathological parameters enhances the prognostic accuracy of NDRD in patients with diabetes, enabling timely therapeutic interventions to mitigate complications in high-risk cases.
Zhou et al. (Mon,) studied this question.