الفهرس 
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Abstract
Diabetes mellitus is a complex metabolic disease characterized by increased level of blood glucose resulting from defects in insulin secretion, insulin action, or both. According to the International Diabetes Federation (IDF), Egypt is one of the top 10 nations in the world for having the most diabetes patients.
Nondiabetic renal diseases (NDRDs) may occur in patients with diabetes and renal involvement including membranous glomerulonephritis, amyloidosis, minimal change disease, focal segmental glomerulosclerosis, myeloma kidney, IgA nephropathy and more.
Due to the difficulty in reversing renal abnormalities in DKD, it is generally agreed that NDRDs have a good prognosis. It is frequently possible to cure and even reverse NDRDs.
Renal biopsy is generally considered the gold diagnostic criteria to evaluate the pathological changes among diabetes mellitus patients with DKD, NDRD, and coexisting DKD and NDRD. It should be considered for identifying NDRD if a diabetic patient whose duration of DM no more than 10 years has urine abnormalities.
The aims of this study were to evaluate the percentage of NDRD among diabetic patients, to identify different pathology of NDRDs based on histological findings, to identify different classes of DKD, to assess chronic changes in the renal biopsy from diabetic patients and to identify possible predictors of presence of NDRD.
The NDRD (isolated and coexisting with DKD) cases constituted 73% (551/754) of the studied cases.
There was a significant difference between DKD group, NDRD group and DKD and NDRD group regarding parameters include age, duration of DM, serum creatinine level, diabetic retinopathy and hematuria.
There was a significant difference between DKD group, NDRD group and DKD and NDRD group regarding parameters include HCV and hypertension.
There was a significant difference between isolated NDRD and coexisting DKD and NDRD groups regarding types of NDRD include acute tubular injury, membranous glomerulonephritis, amyloidosis, infection related glomerulonephritis, minimal change disease, small vessel vasculitis, lupus glomerulonephritis and immune-complex mediated membranoproliferative glomerulonephritis.
Acute tubular injury was the commonest tubulointerstitial disease in the studied cases. Membranous glomerulonephritis was the commonest glomerular disease in isolated NDRD cases and the second most common type of NDRD in the studied cases.
Amyloidosis was the third common type in the studied cases and the second most common NDRD in isolated NDRD group. LECT2 amyloidosis was the commonest type of amyloidosis while AA type and AL types had equal percentage.
The commonest class in isolated DKD group was class IV comprising almost 55% of cases, while the commonest classes noted in the coexisting DKD and NDRD group were class III and class IV consisting each around 30% of cases.
Older age, diabetic retinopathy and duration of diabetes (<10 years) were the significant predictors of NDRD.
Conclusion
from the results of the previous work, we conclude that:
• Importance of renal biopsy in diabetic patients as they have a significant percentage of NDRD, which can certainly be only proven by a kidney biopsy which will lead to improved outcomes.
• In our study, acute tubular injury is the commonest tubulointerstitial disease while membranous glomerulonephritis is the commonest glomerular disease.
• Amyloidosis is the third common NDRD in our study and LECT2 is the commonest type of renal amyloidosis noted.
• Older age, diabetic retinopathy and duration of diabetes (<10 years) are the significant predictors of NDRD.
Recommendations
• Renal biopsy should be recommended for diabetic patients with renal manifestations because a considerable number may have NDRD with or without DKD.
• Full clinical and laboratory data of the cases are strongly recommended to help the identification and prediction of NDRD.
• Full study of renal biopsy in diabetic patients including immunohistochemistry and electron microscopy studies is recommended for proper identification of NDRD types.