Is kidney biopsy mandatory to diagnose Diabetic Nephropathy
Is a kidney biopsy indicated in the diagnosis of Diabetic Nephropathy?
The presence of proteinuria in a patient with DM does not necessarily equate with a diagnosis of Diabetic Nephropathy and could in fact represent another glomerular disease. Major clues that suggest another cause of proteinuria include:
• Signs of another systemic disease
• Onset of proteinuria less than 5 years after diagnosis of type 1 DM
• Absence of retinopathy in a patient with type 1 DM
• Rapid deterioration of kidney function or sudden increases in proteinuria
• Presence of hematuria, red or white blood cell urine casts, pyuria, or abnormal protein chains in the urine
A study by Mazzucco et al. found that using restrictive criteria such as these to determine the need for a kidney biopsy may lead to more than 50% of kidney biopsies having another glomerular disease present.
