Primary focal segmental glomerulosclerosis: clinical and morphological prognostic factors

AIM: To retrospectively analyze clinical course and results of immunodepressive therapy of patients with primary focal-segmental glomerulosclerosis (FSGS), to reveal prognostic factors of the disease progression and patients' sensitivity to immunosuppressive therapy. MATERIAL AND METHODS: Morphological diagnosis was specified, morphological indices of activity and sclerosis were estimated, renal survival was analysed, mono- and multivariate analysis of prognostic factors was made by the evidence obtained in the study of 135 biopsy specimens from CRF patients meeting the criteria of FSGS. RESULTS: At the moment of the disease onset only age of the patients was related to FSGS: 5- and 10-year survival was 100% if the disease started under 16 years of age, if older--the survival was 80 and 65%, respectively. Nephrotic syndrome, hematuria, high creatinine, racemose alterations in the glomeruli worsened the disease prognosis. When cytostatics and corticosteroids were used in combination they produced better results and were associated with better prognosis than each of them in monotherapy. Patients with marked hematuria and low proteinuria were less sensitive to therapy than those with weak hematuria and high proteinemia. Patients with FSGS having high IA and SI required more aggressive therapy for response. CONCLUSION: Renal biopsy with quantitation of IA and IS increases the prognosis accuracy and is important for choice of the treatment policy in patients with primary FSGS.     

Urinary macrophage counts and ratio to T lymphocytes: Possible use in differential diagnosis and management of glomerular disease

The noninvasive method that can differentiate hematuria-positive patients has not yet been developed. We evaluated the clinical value of the analysis of mononuclear cells in urine in combination with urinary erythrocytes as a noninvasive differential diagnostic tool of glomerular disease. The number of macrophages (CD14⁺ cells/ml urine) and T-lymphocytes (CD3⁺ cells/ml urine) were measured by flow cytometry using samples of freshly voided urine from 203 patients with hematuria. They had various types of proliferative glomerular disease, including rapidly progressive glomerulonephritis (RPGN), IgA nephropathy (IgAN), and membranoproliferative glomerulonephritis (MPGN), or nonproliferative glomerulopathy including idiopathic renal hematuria and hereditary nephropathy. Urinary macrophage counts increased significantly with the severity of glomerulonephritis; their number consistently exceeded that of T-lymphocyte counts in patients with active proliferative glomerulonephritis. Urinary macrophage counts in patients with proliferative GN were consistently higher than those of hematuria-matched nonproliferative GN. Moreover, urinary macrophage counts in patients with RPGN were significantly higher than those of MPGN and IgAN. Most of the patients with inactive proliferative glomerulonephritis or with nonproliferative glomerulopathy showed no marked increase in urinary macrophages. Although some patients with nonproliferative glomerulopathy who exhibited gross hematuria showed a slight increase in urinary macrophage counts, such counts were consistently lower than those of T lymphocytes. These observations suggests that urinary macrophage count and its ratio to T-lymphocyte count may provide useful information for clinicians in managing patients with proliferative glomerular disease as well as deciding whether to conduct renal biopsy in patients with hematuria. © 1996 Wiley Liss, Inc.     

328例肾脏疾病患者的肾脏病理分析

目的：了解近年经皮肾活检肾脏疾病患者的病理类型分布及其与临床症状的关系。方法：回顾分析2004年6月～2005年6月间因肾脏疾病住院行肾活检的患者的临床病理特点。结果：328例肾脏疾病中，原发性肾小球疾病257例（78．4％）、小管间质疾病16例（4．9％）、继发性肾脏病55例（16．8％）。原发性肾小球疾病中IgA肾病137例，占53．3％；继发性肾小球肾炎中狼疮肾炎、紫癜性肾炎和高血压肾损害较多，分别占32．7％、27．3％和18．2%；小管间质疾病以急性间质性肾炎为多，占68．8％。IgA肾病主要表现为蛋白尿并血尿；膜性肾病、高血压肾病主要表现为单纯性蛋白尿。单纯血尿主要病理类型是IgA肾病；单纯蛋白尿主要病理类型是IgA肾病和轻微病变。蛋白尿并血尿主要病理类型是IgA肾病、轻微病变和狼疮性肾炎；大量蛋白尿主要病理类型是轻微病变、IgA肾病和膜性肾病。结论：本组资料显示原发性肾小球疾病仍为我国最常见的肾脏疾病，其中以IgA肾病最常见；小管间质疾病发病率有增高，继发性肾脏病以狼疮肾炎最常见，其它特殊肾脏病有增加。     

IgA肾病86例临床和病理分析

目的 :了解IgA肾病患者的临床表现及其病理情况。方法 :对 1984年 6月～ 2 0 0 0年 12月间经肾活检证实为IgA肾病患者 86例随访资料进行分析。结果 :以感染为首次发病诱因者 4 2例 ,其中呼吸道感染 36例。存在血尿 79例 ,蛋白尿 83例 ;伴高血压 4 0例 ;发生急性肾衰竭 4例。治疗前内生肌酐清除率 (Ccr>70ml/min 6 2例 ,5 0～ 70ml/min 15例 ,2 5～ 5 0ml/min 8例 ,<2 5ml/min 1例 ;治疗后Ccr>70ml/min 73例 ,5 0～ 70ml/min 5例 ,2 5～ 5 0ml/min 4例 ,<2 5ml/min 4例。除肾小球系膜增生外 ,病理改变以间质炎症和肾小球硬化出现的比例最高 ,其次为肾小管萎缩、间质纤维化等。结论 :IgA肾病的临床表现以蛋白尿和血尿多见 ,且两者合并存在的机会多见 ;部分患者可出现血压升高及肾功能恶化。IgA肾病患者应早期进行肾活检检查     

伴有肉眼血尿的IgA肾病患者临床特点分析

目的 研究伴有肉眼血尿的IgA肾病患者临床及病理特点,指导临床治疗.方法 经肾活检病理诊断为IgA肾病的患者76例,根据患者病程中是否出现肉眼血尿分为研究组和对照组,研究组22例,病程中均伴有肉眼血尿;对照组54例,不伴有肉眼血尿.应用Katafuchi半定量积分法分析患者肾脏病变程度,结合患者临床特点比较两组患者病理学改变及临床特点.结果 ①研究组患者前驱感染发生率显著高于对照组,高血压发生率低于对照组,血肌酐低于对照组,平均病程短于对照组(P<0.05).两组患者24 h尿蛋白排泄量无统计学差异(P>0.05).②研究组患者肾脏病理积分、血管积分、球硬化积分及血管壁增厚积分低于对照组(P<0.05).结论 伴有肉眼血尿的IgA肾病患者发病期多伴有前驱感染,病程中高血压发生率、血肌酐水平较不伴有肉眼血尿的IgA肾病患者低.病理改变较不伴有肉眼血尿的IgA肾病轻,预后相对较好.     

Management of membranoproliferative glomerulonephritis type II with plasmapheresis

Membranoproliferative glomerulonephritis type II (MPGN II) is a rare kidney disease identified microscopically by electron-dense deposits surrounded by complement component C3 in glomerular basement membranes. MPGN II usually leads to renal failure, and patients with MPGN II experience a high rate of recurrence following renal transplantation. No treatment modalities have been proven successful if recurrence does occur. The sera of most patients with MPGN II contain complement C3 nephritic factor (C3NF), an IgG autoantibody directed against C3 convertase (C3bBb) that results in constitutive breakdown of C3. C3NF may be important in the pathogenesis of the disease. Since C3NF is IgG, we predicted that C3NF could be removed from the serum through plasmapheresis. We describe the use of long-term plasmapheresis to maintain good renal function in a 15-year-old girl with rapidly progressive recurrent MPGN II. After 73 plasmapheresis procedures over 63 weeks, her serum creatinine remained stable, and her creatinine clearance trended upward. Serial biopsies of the transplanted kidney demonstrated persistent MPGN II but no development of tubular atrophy. During the course of therapy, serum C3NF activity decreased; furthermore, C3NF activity was detected in the removed plasma. We have shown that plasmapheresis is a safe and effective method for delaying the onset of chronic renal failure in recurrent MPGN II. The efficacy may be due to the removal of serum C3NF.     

508例肾活检资料的流行病学特点及病理类型与免疫荧光之间的关系

目的探讨江苏地区508例肾活检资料的流行病学特点及病理类型与免疫荧光之间的关系。方法回顾性分析508例因肾脏疾病而行肾活检患者的临床资料。结果 508例患者年龄(36.1±13.6)岁;男242例,女266例。狼疮性肾炎(LN)、肾小管-间质疾病(TID)、膜增生性肾小球肾炎(MPGN)、新月体性肾炎(CREGN)、轻微病变(MGA)及IgA肾病(IgAN)女性居多。原发性肾小球肾炎392例,继发性肾小球肾炎109例。最常见病理类型为IgAN、系膜增生性病变(MsPL)、膜性肾病(MN)、MGA、微小病变(MCNS)、局灶阶段性肾小球硬化症(FSGS)、LN。最常见的临床表现为肾病综合征(NS)、肾炎综合征(CNS)。NS中最常见的病理类型为MCNS、MN、MsPL、IgAN、FSGS、MGA;CNS最常见的病理类型为:IgAN、MsPL。IgAN肾组织以IgA沉积为主;DN肾组织83.3%有不同程度及类型的免疫球蛋白沉积;LN肾组织92.3%病例呈"满堂亮"表现。结论江苏地区肾脏疾病男女比例相当,青壮年是高发人群;最常见的肾小球疾病是IgAN;IgAN肾脏组织以IgA沉积为主;最常见的临床表现是NS;江苏北部Alport综合征发病率较其他地区高。     

慢性前列腺炎诱发大鼠IgA肾病模型血、尿IL-6的变化

目的：探讨慢性前列腺炎（CP）诱发IgA肾病（IgAN）的机制。方法：将63只SD大鼠随机分为A组（单纯切肝组）、B组（单纯前列腺炎组）和C组（前列腺炎＋切肝组）比较3组大鼠尿蛋白、尿红细胞计数、血清肌酐和血、尿IL-6水平，肾组织病变程度，以及IgA、IgG、IgM、补体C3沉积情况，结果：3组大鼠之间尿蛋白、尿红细胞计数以及血清肌酐水平差异无显著性。第25周时，B、C组血、尿IL-6水平较A组高（均P〈0．05），但B组与C组之间无明显差异、第25周时，C组大鼠IgA沉积的阳性率为72．7％（16／22），较A组的25．0％（3／12）和B组的23．1％（3／13）高（P〈0．01）。C组22只大鼠16只系膜轻度增殖，系膜区以IgA沉积为主，75．0％伴有IgG和（或）IgM沉积；均无补体C3沉积；无明显血尿、蛋白尿。结论：CP在网状内皮系统功能低下可诱发大鼠IgAN：CP耐，前列腺局部产生的IL-6水平增加．可能参与了CP诱发IgAN的这一过程。     

Renal manifestations of hepatitis C virus infection. Extrahepatic complications often are silent--and thus overlooked

Renal involvement often occurs in HCV infection. The most common renal manifestation is MPGN with or without cryoglobulinemia. Patients with glomerulonephritis may have no clinical evidence of systemic or liver involvement. Pathogenesis of HCV-associated MPGN is mediated by glomerular deposition of circulating immune complexes containing HCV and anti-HCV. The treatment of choice for MPGN is IFN-alpha. However, success is limited, and many patients fail to respond or experience relapse on discontinuation of therapy. Newer treatment modalities, such as high-dose IFN-alpha and recombinant IFN alpha-2b and ribavirin combination therapy, have led to improved suppression of HCV RNA levels.     

IgA肾病伴肾功能进展患者肾脏病理学特点

目的 探讨lgA肾病患者慢性肾功能进展的病理风险因素.方法 随访309例lgA肾病患者,随访期内,按是否肌酐倍增或进入终末期肾病,将患者分为肾功能稳定组(253例)和肾功能进展组(56例),对比2组患者肾脏病理资料.结果 ①免疫荧光:2组患者相比较,IgA、IgM等各类免疫病理沉积物半定量均无统计学意义(P均＞0.05).②病理评分:除血管指数外,余肾脏病理评分指标如肾小球指数、硬化指数、新月体指数和问质指数在肾功能进展组显著增高(P均＜0.05).③回归分析:以肾穿刺时的SCr水平为因变量,与病理评分指标作直线逐步回归分析,相关密切的分别是硬化指数、新月体数和间质指数(P均＜0.05).结论 免疫沉积物的种类或数量可能和肾功能是否进展不相关;较重的肾小球增生硬化、新月体形成和间质改变可能是肾功能进展的病理风险因素.     

IgA-dominant postinfectious glomerulonephritis: a new twist on an old disease

IgA-dominant acute postinfectious glomerulonephritis (APIGN) is an increasingly recognized morphologic variant of APIGN, particularly in the elderly. In contrast to classic APIGN, in which there is typically glomerular deposition of IgG and C3 or C3 only, IgA is the sole or dominant immunoglobulin in IgA-dominant APIGN. Because the vast majority of reported cases occur in association with staphylococcal infections, the alternative designation 'IgA-dominant acute poststaphylococcal glomerulonephritis' has been applied. Diabetes is a major risk factor, likely reflecting the high prevalence of staphylococcal infection in diabetics, particularly involving skin. Patients typically present with severe renal failure, proteinuria and hematuria. Prognosis is guarded with less than a fifth of patients fully recovering renal function. This variant of APIGN must be distinguished from IgA nephropathy. Features that favor IgA-dominant APIGN over IgA nephropathy include initial presentation in older age or in a diabetic patient, acute renal failure, intercurrent culture-documented staphylococcal infection, hypocomplementemia, diffuse glomerular endocapillary hypercellularity with prominent neutrophil infiltration on light microscopy, stronger immunofluorescence staining for C3 than IgA, and the presence of subepithelial humps on electron microscopy. The pathogenetic mechanism of selective IgA deposition in patients with poststaphylococcal glomerulonephritis likely involves specific host responses to the inciting pathogen.     

Acanthocytes in the urine: useful tool to differentiate diabetic nephropathy from glomerulonephritis?

OBJECTIVE: The presence of hematuria has been suggested to indicate nondiabetic nephropathy in diabetic patients with proteinuria. However, hematuria is frequently found in patients with biopsy-proven diabetic glomerulosclerosis without nondiabetic nephropathy. Urine microscopy allows discrimination of glomerular hematuria, which is defined as acanthocyturia (urinary excretion of acanthocytes, which are dysmorphic erythrocytes with vesicle-like protrusions), from nonglomerular hematuria. We hypothesized that acanthocyturia is an uncommon finding in diabetic nephropathy, which suggests the presence of a nondiabetic nephropathy in diabetic patients with proteinuria. RESEARCH DESIGN AND METHODS: Urine samples of patients with the clinical diagnosis of diabetic nephropathy (n = 68), of patients with biopsy-proven glomerulonephritis (n = 43), and of age-matched healthy control subjects (n = 20) were examined by phase-contrast microscopy for the presence of hematuria (>/=8 erythrocytes/ micro l) and acanthocyturia. Acanthocyturia of >/=5% (5 acanthocytes among 100 excreted erythrocytes) was classified as glomerular hematuria; acanthocyturia of 2-4% was classified as suspected glomerular hematuria. RESULTS: Hematuria was found in 62% of patients with the clinical diagnosis of diabetic nephropathy, in 84% of patients with glomerulonephritis, and in 20% of the healthy control subjects upon a single urine examination. In contrast, glomerular hematuria occurred in 4% of patients with diabetic nephropathy and in 40% of patients with glomerulonephritis (P < 0.001). CONCLUSIONS: In contrast to hematuria, acanthocyturia is uncommon in patients with the clinical diagnosis of diabetic nephropathy. In diabetic patients with proteinuria, the finding of acanthocyturia points to nondiabetic glomerulopathies, and renal biopsy should be considered.     

Renal disorders in rheumatoid arthritis]

Glomerulonephritis has been believed to be a rare complication in rheumatoid arthritis (RA). However, recent studies have revealed a focal segmental increase in mesangial cells and matrix in RA patients with hematuria. In our series, proteinuria, hematuria or both abnormalities were recognized in 74 (22%) out of 336 RA cases. Among 119 patients examined by renal biopsy, mild mesangial proliferative glomerulonephritis (GN) was found in 25 patients, of which 22 demonstrated mesangial IgA deposits, by immunofluorescent microscopy. Membranous nephropathy was noticed in 26 cases. Three cases of membranous nephropathy had no history of gold or D-penicillamine treatment. Electron microscopy revealed diffuse thinning of the glomerular basement membrane in 12 cases. The average thickness of the glomerular basement membrane was significantly thinner in RA patients than in normal subjects. The immunological processes associated with rheumatoid factor do not seem to be related to the renal lesions in RA patients.     

Alpha-2-macroglobulin in children with glomerular diseases (author's transl)]

The serum and urine levels of alpha-2-macroglobulin (alpha2-MG) was determined in 33 children with glomerular diseases and in 26 healthy control children. Healthy children showed a minimum level of 275 mg% and maximum level of 337 mg%, with a mean concentration of 301 mg% and a standard deviation of 13 mg%. No alpha2-MG was detected in the urine. Steroid-treated patients with idiopathic nephrotic syndrome displayed elevated inhibitor levels of up to 490 mg%. This might be a direct result of steroid therapy or a consequence of reactively-increased protein synthesis in response to the renal protein loss. In all these patients the urine was found to be alpha2-MG-negative, irrespective of the presence or absence of proteinuria. In the miscellaneous group of glomerulopathies without the nephrotic syndrome, serum levels of alpha2-MG were shown to be normal. The urinary concentrations of alpha2-MG were related to the activity of the disease. alpha2-MG determination in serum and urine seems to be a tool for differential diagnosis and prognosis in some cases of glomerular disease.     

川西南地区68例膜性肾病临床与病理分析

目的了解我国川西南地区膜性肾病(MN)的临床特征及其与病理改变的关系。方法回顾性分析2003年至2010年间在四川省攀枝花市中心医院肾内科住院的68例MN患者(均经肾活检及临床确诊),对其临床资料、病理特征进行统计分析。结果 (1)68例MN的病因主要为特发性膜性肾病(IMN),占82.4%;其次为狼疮性肾炎,占11.8%;乙型病毒性肝炎、类风湿性关节炎、干燥综合征少见,分别占2.9%、1.5%、1.5%。(2)68例MN患者临床表现为肾病综合征、慢性肾炎及隐匿性肾炎,分别占70.6%、22.1%及7.4%;伴有镜下血尿、高血压及肾功能不全者分别为52.9%、14.7%及4.4%。(3)Ⅰ、Ⅱ、Ⅲ和Ⅳ期分别占52.9%、44.1%、1.5%和1.5%。性别、年龄、高血压、血清白蛋白、胆固醇、24h尿蛋白定量及内生肌酐清除率水平等在不同肾小球病理分期间无显著差异。结论 (1)川西南地区MN病因主要为特发性膜性肾病,其次为狼疮性肾炎;(2)MN临床表现主要为肾病综合征,镜下血尿、高血压、肾功能不全的发生率与国外接近;(3)MN病理改变以I期、Ⅱ期为主;临床表现特征与肾小球病理分期无明显相关。     

Diagnostic value of serum cystatin C for evaluation of hepatorenal syndrome

BACKGROUND: The evaluation of renal function in patients with decompensated cirrhosis is important for prognosis, dosage assessment of potentially nephrotoxic drugs and recognition of changes in glomerular filtration rate (GFR) to decide paracentesis and diuretic therapy. Patients with many different disorders of hepatic function can present with various abnormalities of renal function in the absence of other known causes of renal failure which has been called hepatorenal syndrome (HRS). Some reports have pointed out that serum creatinine levels frequently failed to rise above normal levels even when glomerular filtration rate (GFR) is very low in cirrhotic patients with hepatorenal syndrome. The aim of this study was to determine if estimation of serum cystatin C could replace creatinine clearance in routine GFR determinations for patients with cirrhosis. METHODS: Serum cystatin C, creatinine clearance (Clcr), and 99mTc-DTPA clearance were determined in 26 patients with cirrhosis. According to Child-Pugh's classification, 21 patients were in group C and 5 were in Group B. RESULTS: Pearson correlation analyses showed that correlation between serum cystatin C and 99mTc-DTPA clearance was r=-0.522, p=0.006, between serum creatinine and 99mTc-DTPA was r=-0.373, p=0.06. The results of our study demonstrated that neither serum creatinine nor creatinine clearance (Clcr) were good indicators of hepatorenal syndrome because the mean value for Clcr was found to be higher than Tc-DTPA clearance, and there was no correlation between these two parameters (r=0.059). Additionally, the mean value of serum creatinine was found to be within the normal range, whereas the mean DTPA clearance level was lower than normal range. CONCLUSIONS: This finding could be explained by the fact that cirrhotic patients with poor nutrition may have decreased protein intake, low muscle mass and lack of converting capacity of creatine to creatinine. Thus, we suggest that serum cystatin C assay, which has good analytical performance, could replace or at least be added to creatinine measurement for GFR assessment in patients with cirrhosis.     

Significance of serum IgA levels and serum IgA/C3 ratio in diagnostic analysis of patients with IgA nephropathy

Diagnostic analysis of clinical markers including serum IgA levels and serum IgA/C3 ratio in patients with IgA nephropathy is described. One hundred patients with IgA nephropathy (IgA nephropathy group) and 100 patients with other primary glomerular diseases (non-IgA nephropathy group) were examined. The analysis was performed to distinguish between these two groups using four clinical markers: 1) more than five red blood cells in urinary sediments, 2) persistent proteinuria (urinary protein of more than 0.3 g/day), 3) serum IgA levels of more than 315 mg/dl, and 4) a serum IgA/C3 ratio of more than 3.01. Patients with three or four clinical markers were easily diagnosed as having IgA nephropathy in this study. Furthermore, there was a significant difference in these clinical markers between the good prognosis and relatively good prognosis groups (Groups I and II) and the relatively poor prognosis and poor prognosis groups (Groups III and IV) of IgA nephropathy patients. It appears that the presence of microscopic hematuria and/or persistent proteinuria, high serum IgA levels, and the serum IgA/C3 ratio are useful for distinguishing IgA nephropathy from other primary renal diseases. It is postulated that these clinical markers are also useful for diagnosis of IgA nephropathy without renal biopsy.     

A descriptive study of individuals with membranoproliferative glomerulonephritis.

OBJECTIVE: Membranoproliferative Glomerulonephritis (MPGN) is one of a group of glomerulonephritides that often begins in childhood and progresses to renal failure. The purpose of this paper is to describe the initial results of a patient-driven database on individuals with MPGN. SAMPLE/SETTING: Patients with MPGN Types I, II, and III and their family members were recruited to this survey study. DESIGN: A population survey design was used. METHODS: A survey was developed for this study that obtained information from the individual with MPGN or a guardian on: patient information, family/patient health history, history of PGN, medications, course of MPGN, history of dialysis, and history of transplant. Surveys were completed either on-line or in paper format. RESULTS: Fifty-nine individuals who are primarily white (80%) and female (61%) with MPGN Type II (52%) participated in this study. The average age of onset of MPGN in this sample was 12 years. Ten (71%) of the total 14 patients with onset of less than 10y ears of age were female. Among these 10 female, 8 (80%) were diagnosed with MPGN II and developed end stage renal disease. CONCLUSION: Health screenings for blood pressure, urinary dipstick for both proteinuria and hematuria play important roles in early detection for MPGN. Nurses must provide emotional and information support to this population.     

Renal outcome in type 2 diabetic patients with or without coexisting nondiabetic nephropathies

OBJECTIVE: To determine the risk factors for adverse renal outcome in type 2 diabetic patients who underwent renal biopsy and were followed-up longitudinally. RESEARCH DESIGN AND METHODS: We examined 68 consecutive patients with type 2 diabetes during the period of 1985-1999 who underwent renal biopsy for proteinuria > or =1 g/day, renal involvement (proteinuria or renal impairment) at the absence of retinopathy, renal involvement with duration of diabetes < 5 years, or unexplained hematuria of glomerular origin. Their clinical features and underlying renal lesion were correlated with the renal outcome after longitudinal follow-up. Three groups of patients were defined based on their renal pathology: group I consisted of 24 patients (35%) with diabetic glomerulosclerosis (DGS) alone, group II consisted of 13 patients (19%) with nondiabetic nephropathy (NDN) superimposed on DGS, and group III consisted of 31 patients (46%) with NDN alone without evidence of DGS. RESULTS: After a mean follow-up of 123 months from the diagnosis of type 2 diabetes (74 months from the time of renal biopsy), univariate analysis showed that risk factors for reaching end-stage renal disease (requiring maintenance dialysis, or a serum creatinine [SCr] > or =700 micromol/l) included proteinuria > or = 2g/day (P = 0.0087), SCr >120 micromol/l (P = 0.0005), presence of retinopathy (P < 0.00001) at the time of biopsy, and biopsy showing DGS (groups I and II) (P = 0.035). On multivariate analysis, retinopathy was the only independent variable correlated with end-stage renal failure. This study also showed that the association of hematuria or proteinuria with the absence of retinopathy constitutes the strongest indication for a nondiabetic lesion (positive predictive values of 94%). CONCLUSIONS: Patients with type 2 diabetes undergoing renal biopsy constitute a heterogeneous group by their clinical presentations and underlying pathology, but longitudinal studies on the renal outcome of these patients remain limited. Our study showed that renal biopsy is indicated in selective diabetic patients because of potentially treatable nephropathy and of a better prognosis than DGS.