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Serum levels of immunoglobulin G and complement 3 differentiate non-diabetic renal disease from diabetic nephropathy in patients with type 2 diabetes mellitus

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Abstract

Aims

Heavy proteinuria caused by non-diabetic renal disease (NDRD) is common in type 2 diabetes mellitus (T2DM). The aim of this study was to investigate specific predictors for NDRD in addition to traditional indicators in T2DM.

Methods

A total of 341 patients with T2DM who underwent renal biopsy were retrospectively included. Eligible patients were divided into a nephrotic-range group (n = 194) and a non-nephrotic-range group (n = 147) based on proteinuria level. Risk factors for NDRD were evaluated using logistic regression, and the diagnostic implications of these variables were assessed by subgroup.

Results

Multivariate logistic regression indicated that serum IgG level (OR, 0.762; 95% CI, 0.628–0.924; p = 0.006) was an independent predictor of NDRD in the nephrotic-range group. However, in the non-nephrotic-range group, increased C3 level was an independent risk factor for NDRD (OR, 1.313; 95% CI, 1.028–1.678; p = 0.029). In the nephrotic-range group, the optimal cutoff value of IgG for predicting NDRD was 734.0 mg/dl, with 67.8% sensitivity and 74.8% specificity, and IgG ≤ 734.0 mg/dl was the best predictor of NDRD. In the non-nephrotic-range group, the optimal cutoff value of C3 for predicting NDRD was 122.0 mg/dl with low sensitivity (30.9%) but high specificity (97.8%).

Conclusions

At different levels of proteinuria, reduced IgG and increased C3 levels were independent indicators of NDRD in T2DM. Insights into these factors will help to advance the clinical management of NDRD.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (Grant Number 81670662).

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Authors and Affiliations

  1. Division of Nephrology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China

    Junlin Zhang, Yiting Wang, Rui Zhang, Hanyu Li, Qianqian Han, Yucheng Wu, Shanshan Wang, Ruikun Guo, Tingli Wang, Li Li & Fang Liu

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  1. Junlin Zhang
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  2. Yiting Wang
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  11. Fang Liu
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Correspondence to Fang Liu.

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The ethics committee of West China Hospital approved this research. The study protocol was in compliance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Zhang, J., Wang, Y., Zhang, R. et al. Serum levels of immunoglobulin G and complement 3 differentiate non-diabetic renal disease from diabetic nephropathy in patients with type 2 diabetes mellitus. Acta Diabetol 56, 873–881 (2019). https://doi.org/10.1007/s00592-019-01339-0

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