Espectro das doenças glomerulares nos pacientes com diabetes submetidos a biópsia renal, em hospital terciário em São Paulo - Brasil
Data
2024-11-12
Autores
Eid, Lucas Pereira Abrão 
Orientadores
Mastroianni Kirsztajn, Gianna
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A doença renal do diabetes (DRD) é a principal causa de doença renal crônica (DRC) no mundo e tem achados histológicos típicos, a chamada nefropatia diabética (ND). A maioria dos pacientes com diabetes mellitus (DM) não é submetida à biópsia renal (Bx). Em caso de DM, a Bx é comumente usada quando há suspeita de outro diagnóstico que não a DRD (por exemplo, glomerulonefrite primária). Bx em pacientes com DRD estabelecida para investigar outra patologia glomerular é um tema que carece de estudos. Objetivos: O objetivo primário é descrever as frequências relativas de outras patologias glomerulares encontradas em Bx realizadas em pacientes com DM em serviço de nefrologia terciário em São Paulo - Brasil, nos anos de 2004 a 2022. Os objetivos secundários são definir quais as principais indicações de realização da Bx nos pacientes incluídos, além de buscar associações e/ou efeitos dos achados clínico-laboratoriais em cada situação. Métodos: Estudo descritivo, em que foram analisados os prontuários dos pacientes incluídos - adultos com DRC e DM bem estabelecida, submetidos a Bx. Foram descritas as frequências relativas e as indicações de Bx. Resultados: Avaliou-se uma amostra de conveniência de 53 pacientes. A ND isolada estava presente em quase metade (24) dos pacientes. A ND foi seguida por: doença de lesões mínimas/GESF (11,3%) e membranosa primária (7,5%). Os pacientes com glomerulopatias primárias não DM apresentaram maiores níveis de proteinúria de 24h (p=0,004) e menor tempo de DM (p=0,010), comparados a ND ou ND/outra glomerulopatia simultaneamente. Comparando os grupos em função dos demais exames laboratoriais/dados clínicos, não foi possível confirmar nenhuma outra relação significante. Discussão: O grupo histopatológico mais frequente foi a ND (45,3%), seguido por glomerulopatias não DM (37,7%) e ND associada a outra glomerulopatia (17,0%). A indicação mais frequente de Bx foi progressão rápida de DRC aliada a proteinúria nefrótica (54,7%). Nossos achados sugerem que, em situações em que se suspeita de evolução atípica da DRC em paciente com DM, a Bx deve ser realizada, considerando a frequência de outras glomerulopatias (não ND) encontradas.
Introduction: Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) worldwide and presents typical histological findings, known as diabetic nephropathy (DN). Most patients with diabetes mellitus (DM) do not undergo renal biopsy. In cases of DM, a biopsy is commonly performed when another diagnosis besides DKD is suspected (e.g., primary glomerulonephritis). Performing renal biopsies in patients with established DKD to investigate other glomerular pathologies is a topic that lacks sufficient studies. Objectives: The primary objective is to describe the relative frequencies of other glomerular pathologies found in renal biopsies performed on patients with DM at a tertiary nephrology service in São Paulo, Brazil, between 2004 and 2022. The secondary objectives are to define the main indications for performing renal biopsies in the included patients and to search for associations and/or effects of clinicallaboratory findings in each situation. Methods: This is a descriptive study analyzing the medical records of adult patients with well-established CKD and DM who underwent renal biopsies. The relative frequencies and indications for renal biopsies were described. Results: A convenience sample of 53 patients was analyzed. Isolated DN was present in almost half (24) of the patients. DN was followed by minimal change disease/focal segmental glomerulosclerosis (11.3%) and primary membranous nephropathy (7.5%). Patients with non-DM/primary glomerulopathies presented higher 24-hour proteinuria levels (p=0.004) and shorter DM duration (p=0.010) compared to those with DN or DN combined with another glomerulopathy. When comparing groups according to laboratory tests/clinical data, no significant relationships could be confirmed. Discussion: The most frequent histopathological group was DN (45.3%), followed by non-DM glomerulopathies (37.7%) and DN associated with another glomerulopathy (17.0%). The most common indication for renal biopsy was rapid CKD progression combined with nephrotic proteinuria (54.7%). Our findings suggest that when na atypical CKD progression is suspected in a patient with DM, a renal biopsy should be performed, considering the frequency of non-DN glomerulopathies found.
Introduction: Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) worldwide and presents typical histological findings, known as diabetic nephropathy (DN). Most patients with diabetes mellitus (DM) do not undergo renal biopsy. In cases of DM, a biopsy is commonly performed when another diagnosis besides DKD is suspected (e.g., primary glomerulonephritis). Performing renal biopsies in patients with established DKD to investigate other glomerular pathologies is a topic that lacks sufficient studies. Objectives: The primary objective is to describe the relative frequencies of other glomerular pathologies found in renal biopsies performed on patients with DM at a tertiary nephrology service in São Paulo, Brazil, between 2004 and 2022. The secondary objectives are to define the main indications for performing renal biopsies in the included patients and to search for associations and/or effects of clinicallaboratory findings in each situation. Methods: This is a descriptive study analyzing the medical records of adult patients with well-established CKD and DM who underwent renal biopsies. The relative frequencies and indications for renal biopsies were described. Results: A convenience sample of 53 patients was analyzed. Isolated DN was present in almost half (24) of the patients. DN was followed by minimal change disease/focal segmental glomerulosclerosis (11.3%) and primary membranous nephropathy (7.5%). Patients with non-DM/primary glomerulopathies presented higher 24-hour proteinuria levels (p=0.004) and shorter DM duration (p=0.010) compared to those with DN or DN combined with another glomerulopathy. When comparing groups according to laboratory tests/clinical data, no significant relationships could be confirmed. Discussion: The most frequent histopathological group was DN (45.3%), followed by non-DM glomerulopathies (37.7%) and DN associated with another glomerulopathy (17.0%). The most common indication for renal biopsy was rapid CKD progression combined with nephrotic proteinuria (54.7%). Our findings suggest that when na atypical CKD progression is suspected in a patient with DM, a renal biopsy should be performed, considering the frequency of non-DN glomerulopathies found.
Descrição
Citação
EID, Lucas Pereira Abrão. Espectro das doenças glomerulares nos pacientes com diabetes submetidos a biópsia renal, em hospital terciário em São Paulo - Brasil. 2024. 69 f. Dissertação (Mestrado em Nefrologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2024.