Short-Term Outcomes of Infection-Related Glomerulonephritis in Diabetes Mellitus

TL;DR

This study examines the short-term outcomes of infection-related kidney disease in diabetic patients, finding that certain factors like anuria and kidney damage are linked to poor recovery.

Contribution

The study identifies clinicopathological predictors of poor renal recovery in diabetic patients with infection-related glomerulonephritis.

Findings

Anuria or uremia at presentation correlates with poor renal recovery in diabetic IRGN patients.

Diabetic nephropathy, glomerulosclerosis >28.6%, and IFTA >17.5% are associated with poor outcomes.

Complement levels and crescent prevalence do not affect IRGN outcomes in diabetic patients.

Abstract

Background and objective

Infection-related glomerulonephritis (IRGN) in adults, particularly the diabetic population, has a grave prognosis with many patients progressing to dialysis-dependent renal failure. Indian data on this entity are very scarce. This study attempts to correlate the clinicopathological factors related to diabetic IRGN and its short-term outcomes.

Subjects and methods

A retrospective analysis of all diabetic patients with biopsy-proven IRGN between January 2017 and August 2021 was conducted. Factors affecting outcomes such as clinical characteristics, urine examination, complete blood count, serum biochemistry, renal biopsy, and follow-up data were obtained and analyzed to determine the risk of progression to chronic kidney disease (CKD)/end-stage renal disease (ESRD). Univariate/multivariate analysis and receiver operating characteristic (ROC) curve were performed to identify independent risk factors affecting outcomes.

Results

A total of 40 diabetic patients with IRGN was included in the study, with a mean age of 53.08 ± 10 years, comprising predominantly males (60%). Infective foci were occult in majority (37.5%). Isolated low C3 levels were documented in the majority, while three patients (7.5%) had normal complement levels. Complete renal recovery was noted in 15 patients (37.5%), while 12 patients (30%) progressed to ESRD. Anuria or uremia at presentation, glomerulosclerosis >28.6%, interstitial fibrosis with tubular atrophy (IFTA) >17.5%, and diabetic nephropathy correlated to poor renal recovery. No correlation was observed between endocapillary proliferation, the pattern of deposits, the prevalence of crescents, and complement levels with the outcome.

Conclusion

IRGN is a common immune-mediated clinical entity among diabetics and often requires renal replacement therapy. Anuria or uremia at presentation, diabetic nephropathy, elevated glomerulosclerosis, and IFTA were associated with poor renal recovery. Complement levels and crescents had no impact on the outcome.

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