The most common cause of end-stage renal disease is diabetic kidney disease (DKD), a chronic kidney disease brought on by diabetes and associated comorbidities. A variety of factors, some of which but not all produce proteinuria, affect the etiology of DKD. Hypertension is one factor that might modify DKD. As a result, it was challenging to understand the spectrum of DKD, which is still an open problem. For a study, researchers sought to categorize and describe DKD.

They looked at autopsy specimens from people with type 2 diabetes mellitus (DM) (n=44) and people without DM (n=21).

Patients with proteinuric DKD had a greater incidence of interstitial fibrosis and tubular atrophy than those with non-proteinuric DKD. Hypertension was linked to polar vasculosis in DKD patients. In addition, an unsupervised hierarchical clustering technique discovered a spectrum of renal histopathology findings for DKD with greater and less proteinuria. The pathophysiology of DKD may be altered due to modifications in the diagnostic standards for hypertension and improvements in antihypertensive medications. A decision tree model also revealed the interaction between diabetes, hypertension, and dyslipidemia in predicting the features of DKD.

Polar vasculosis is a reliable sign when DM and hypertension are present. Furthermore, the interactions of diabetes, hypertension, and dyslipidemia were linked to the histopathological and clinical spectrum of DKD. Therefore, when performing clinical trials, these histopathological and clinical data may be useful in illustrating the spectrum of patient features and in establishing whether chronic kidney disease is brought on by DM or another factor.

Reference: onlinelibrary.wiley.com/doi/10.1111/nep.14044