M. K. Mohandas1, Sajeevkumar K. S2, Jacob George3
BACKGROUND
Rapid decline of renal function in a diabetic patient suggests the presence of non-diabetic kidney disease. Incidence of this varies with different geographical areas and socioeconomic groups. The aim of the study is to study the clinical profile and outcome of patients with type 2 diabetes mellitus for more than 5 years who present with rapid decline in GFR (>10 mL/mins. per year).
MATERIALS AND METHODS
This was a prospective observational study conducted in the Department of Nephrology, Government Medical College Hospital, Thiruvananthapuram, over a period of 5 years from 1st January 2008 to 31st December 2012. We included patients with type 2 diabetes mellitus for more than 5 years having a disproportionate decline in GFR (>10 mL/mins. per year) and having at least one of the following; (1) Antecedent infection other than UTI; (2) Microscopic or macroscopic haematuria with negative urine culture; (3) Low C3; (4) Absence of diabetic retinopathy. eGFR was calculated using modified MDRD equation.
RESULTS
54 patients were enrolled in the study. The mean duration of diabetes in the study population was 8.3±2.8 years. 40 cases (74.1%) had non-diabetic glomerular pathology of which 24 (44.4%) were due to Diffuse Proliferative Glomerulonephritis (DPGN). 9 patients with DPGN had crescents. All patients with crescentic DPGN had antecedent skin infection. All patients with crescentic DPGN were oliguric and required haemodialysis. 6 out of 9 (66.7%) patients with crescentic DPGN died.
CONCLUSION
Rapid decline in GFR in any patient with diabetes irrespective of the duration point towards non-diabetic aetiology. DPGN was the most common non-diabetic glomerular pathology observed in our study probably because of high prevalence of skin infection in tropical climate. Crescentic DPGN had invariably a bad prognosis.
