Korean J Intern Med.  2020 Sep;35(5):1173-1187. 10.3904/kjim.2020.195.

Current findings of kidney biopsy including nephropathy associated with hypertension and diabetes mellitus in Korea

Affiliations
  • 1Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
  • 2Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  • 3Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
  • 4Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
  • 5Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
  • 6Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
  • 7Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
  • 8Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

Abstract

Background/Aims
This study aimed to investigate long-term temporal trends and outcomes of biopsy-proven kidney diseases in a multicenter kidney biopsy cohort, focusing on hypertension and diabetes, the leading causes of end-stage kidney disease (ESKD).
Methods
The study included a total of 21,426 patients who underwent kidney biopsy from 1979 to 2018 in 18 hospitals in Korea. We selected subgroups of adults with diabetes (n = 2,813) or clinically presumed hypertensive nephrosclerosis (HTN, n = 2,917). Clinical, demographic, and laboratory data were collected in conjunction with pathologic findings. The prevalence of pathologically confirmed kidney diseases over time and their associations with clinical outcomes were evaluated.
Results
The prevalence of biopsy-proven diabetic nephropathy (DN) has increased significantly from 2.5% to 6.0% in the total cohort in the recent 30 years with an increase in the prevalence of diabetes. Approximately 68% of total diabetic patients had non-diabetic renal disease (NDRD); the proportion was retained since 2000s. DN showed a significantly higher risk of ESKD than NDRD (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.35 to 1.88). The prevalence of biopsy- proven HT-N remained < 2% in the total cohort for several decades. There was no difference in risks of ESKD between patients with or without biopsy-proven HT-N (HR, 0.93; 95% CI, 0.54 to 1.59).
Conclusions
In recent decades, the prevalence of diabetes and DN has significantly increased in the kidney biopsy cohort, showing an increased risk of ESKD. Despite the large numbers of patients meeting the clinical criteria of HT-N, most of those were diagnosed with pathologic diagnoses other than HT-N.

Keyword

Diabetic nephropathies; Nephrosclerosis; Glomerulonephritis; Biopsy
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