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Renal biopsy in patients with diabetes : a pooled meta-analysis of 48 studies

Marco Fiorentino, Davide Bolignano, Vladimir Tesar, Anna Pisano, Wim Van Biesen UGent, Giovanni Tripepi, Graziella D'Arrigo and Loreto Gesualdo (2017) NEPHROLOGY DIALYSIS TRANSPLANTATION. 32(1). p.97-110
abstract
Background. The utility of renal biopsy in patients with diabetes is highly debated. Diabetics with rapidly worsening renal disease are often 'clinically' labelled as having diabetic nephropathy (DN), whereas, in many cases, they are rather developing a nondiabetic renal disease (NDRD) or mixed forms (DN + NDRD). Methods. We performed a systematic search for studies on patients with diabetes with data on the frequency of DN, NDRD and mixed forms, and assessed the positive predictive values (PPVs) and odds ratios (ORs) for such diagnoses by meta-analysing single-study prevalence. Possible factors explaining heterogeneity among the different diagnoses were explored by meta-regression. Results. In the 48 included studies (n = 4876), the prevalence of DN, NDRD and mixed forms ranged from 6.5 to 94%, 3 to 82.9% and 4 to 45.5% of the overall diagnoses, respectively. IgA nephropathy was the most common NDRD (3-59%). PPVs for DN, NDRD and mixed forms were 50.1% [95% confidence interval (CI): 44.7-55.2], 36.9% (95% CI: 32.3-41.8) and 19.7% (95% CI: 16.3-23.6), respectively. The PPV when combining NDRD and mixed forms was 49.2% (95% CI: 43.8-54.5). Meta-regression identified systolic pressure, HbA1c, diabetes duration and retinopathy as factors explaining heterogeneity for NDRD, creatinine and glomerular filtration rate for mixed forms and only serum creatinine for DN. ORs of DN versus NDRD and mixed forms were 1.71 (95% CI: 1.54-1.91) and 4.1 (95% CI: 3.43-4.80), respectively. Conclusions. NDRD are highly prevalent in patients with diabetes. Clinical judgment alone can lead to wrong diagnoses and delay the establishment of adequate therapies. Risk stratification according to individual factors is needed for selecting patients who might benefit from biopsy.
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author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
CLINICAL PREDICTORS, MELLITUS PATIENTS, DISEASE, NEPHROPATHY, PREVALENCE, RETINOPATHY, LESIONS, EXPERIENCE, PATTERNS, GLOMERULOSCLEROSIS, diabetes, diabetic nephropathy, meta-analysis, non-diabetic nephropathy, renal biopsy
journal title
NEPHROLOGY DIALYSIS TRANSPLANTATION
Nephrol. Dial. Transplant.
volume
32
issue
1
pages
97 - 110
Web of Science type
Article
Web of Science id
000397023000015
ISSN
0931-0509
1460-2385
DOI
10.1093/ndt/gfw070
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
8519633
handle
http://hdl.handle.net/1854/LU-8519633
date created
2017-05-05 06:56:46
date last changed
2017-05-23 13:15:43
@article{8519633,
  abstract     = {Background. The utility of renal biopsy in patients with diabetes is highly debated. Diabetics with rapidly worsening renal disease are often 'clinically' labelled as having diabetic nephropathy (DN), whereas, in many cases, they are rather developing a nondiabetic renal disease (NDRD) or mixed forms (DN + NDRD). 
Methods. We performed a systematic search for studies on patients with diabetes with data on the frequency of DN, NDRD and mixed forms, and assessed the positive predictive values (PPVs) and odds ratios (ORs) for such diagnoses by meta-analysing single-study prevalence. Possible factors explaining heterogeneity among the different diagnoses were explored by meta-regression. 
Results. In the 48 included studies (n = 4876), the prevalence of DN, NDRD and mixed forms ranged from 6.5 to 94\%, 3 to 82.9\% and 4 to 45.5\% of the overall diagnoses, respectively. IgA nephropathy was the most common NDRD (3-59\%). PPVs for DN, NDRD and mixed forms were 50.1\% [95\% confidence interval (CI): 44.7-55.2], 36.9\% (95\% CI: 32.3-41.8) and 19.7\% (95\% CI: 16.3-23.6), respectively. The PPV when combining NDRD and mixed forms was 49.2\% (95\% CI: 43.8-54.5). Meta-regression identified systolic pressure, HbA1c, diabetes duration and retinopathy as factors explaining heterogeneity for NDRD, creatinine and glomerular filtration rate for mixed forms and only serum creatinine for DN. ORs of DN versus NDRD and mixed forms were 1.71 (95\% CI: 1.54-1.91) and 4.1 (95\% CI: 3.43-4.80), respectively. 
Conclusions. NDRD are highly prevalent in patients with diabetes. Clinical judgment alone can lead to wrong diagnoses and delay the establishment of adequate therapies. Risk stratification according to individual factors is needed for selecting patients who might benefit from biopsy.},
  author       = {Fiorentino, Marco and Bolignano, Davide and Tesar, Vladimir and Pisano, Anna and Van Biesen, Wim and Tripepi, Giovanni and D'Arrigo, Graziella and Gesualdo, Loreto},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keyword      = {CLINICAL PREDICTORS,MELLITUS PATIENTS,DISEASE,NEPHROPATHY,PREVALENCE,RETINOPATHY,LESIONS,EXPERIENCE,PATTERNS,GLOMERULOSCLEROSIS,diabetes,diabetic nephropathy,meta-analysis,non-diabetic nephropathy,renal biopsy},
  language     = {eng},
  number       = {1},
  pages        = {97--110},
  title        = {Renal biopsy in patients with diabetes : a pooled meta-analysis of 48 studies},
  url          = {http://dx.doi.org/10.1093/ndt/gfw070},
  volume       = {32},
  year         = {2017},
}

Chicago
Fiorentino, Marco, Davide Bolignano, Vladimir Tesar, Anna Pisano, Wim Van Biesen, Giovanni Tripepi, Graziella D’Arrigo, and Loreto Gesualdo. 2017. “Renal Biopsy in Patients with Diabetes : a Pooled Meta-analysis of 48 Studies.” Nephrology Dialysis Transplantation 32 (1): 97–110.
APA
Fiorentino, M., Bolignano, D., Tesar, V., Pisano, A., Van Biesen, W., Tripepi, G., D’Arrigo, G., et al. (2017). Renal biopsy in patients with diabetes : a pooled meta-analysis of 48 studies. NEPHROLOGY DIALYSIS TRANSPLANTATION, 32(1), 97–110.
Vancouver
1.
Fiorentino M, Bolignano D, Tesar V, Pisano A, Van Biesen W, Tripepi G, et al. Renal biopsy in patients with diabetes : a pooled meta-analysis of 48 studies. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2017;32(1):97–110.
MLA
Fiorentino, Marco, Davide Bolignano, Vladimir Tesar, et al. “Renal Biopsy in Patients with Diabetes : a Pooled Meta-analysis of 48 Studies.” NEPHROLOGY DIALYSIS TRANSPLANTATION 32.1 (2017): 97–110. Print.