Membranous nephropathy occurring with type 2 diabetes mellitus

BACKGROUND: The incidence of type 2 diabetes mellitus (T2DM) is increasing, and membranous nephropathy (MN) occurs frequently with T2DM. We investigated the clinicopathological features and outcomes of patients with T2DM and MN. METHODS: A total of 137 patients with biopsy-proven MN and T2DM were enrolled in this retrospective study. Another 100 MN patients without diabetes mellitus served as a control group. The clinicopathological features, treatment responses, and outcomes were analyzed and compared between groups. RESULTS: According to the renal biopsy findings, isolated MN (D group) was observed in 86 patients, and MN superimposed on diabetic nephropathy (DN) (DN group) was observed in 51 patients. The mean age at the time of renal biopsy and the rate of hypertension in patients with MN were higher than in the control group. Male gender (odds ratio (OR), 2.887; 95% CI, 1.244 - 6.702), duration of diabetes (OR, 1.009; 95% CI, 1.001 - 1.016,), and diabetic retinopathy (OR, 2.862; 95% CI, 1.219 - 6.721) were independent predictors of DN. Lesions due to global glomerulosclerosis, interstitial fibrosis/tubular atrophy (IFTA), and the afferent arterioles were more severe in patients with diabetic MN. There were no differences in the rates of complete remission (CR) between the D and control groups. CONCLUSIONS: Diabetic MN usually presents in ageing and clinically hypertensive patients and is associated with severe global glomerulosclerosis, IFTA, and afferent arterial lesions histologically. Patients with pure MN with DM can frequently achieve remission. Gender (male), duration of diabetes, and diabetic retinopathy may serve as indicators of DN. .