Criteria to indicate Kidney biopsy in type 2 diabetic patients with proteinuria: Survey among French nephrologists

Critères d’indications de la biopsie rénale chez les patients diabétiques de type 2 protéinuriques : enquête auprès des néphrologues français

Jonathan Maurice Chemouny (1, 2, 3) , Aurélie Sannier (4) , Guillaume Hanouna (4) , Quentin Raimbourg (4) , Eric Daugas (5) , Cécile Vigneau (6, 3, 1) , François Vrtovnsik (5, 4)

1 UR Médecine - Université de Rennes - Faculté de Médecine
2 MICALIS - MICrobiologie de l'ALImentation au Service de la Santé
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
5 CRI (UMR_S_1149 / ERL_8252 / U1149) - Centre de recherche sur l'Inflammation
6 Irset - Institut de recherche en santé, environnement et travail

Diabetic nephropathy is usually a presumptive diagnosis based on clinical and biological evidence. Renal biopsies are performed in diabetic patients with atypical findings evoking non-diabetic renal disease who could benefit from specific therapies. French speaking nephrologists were asked which criteria they retain to indicate renal biopsy in patients with type 2 diabetes and albuminuria>0.5g/day or equivalent through an online anonymous questionnaire. Among the suggested criteria were absence of diabetic retinopathy, hematuria, rapid decrease in GFR, short diabetes duration or rapid raise of proteinuria. 188 people answered the poll among whom interns (12%), fellows (13%), university hospital practitioners (26%), general hospital practitioners (24%), practitioners in a non-profit organization (13%), practitioners on private activity (10%), multi-modal practitioners (3%) and people without clinical activity (2%). Increasing proteinuria was retained as an indication criterion for renal biopsy by 51% of respondents, nephrotic syndrome by 56% of respondents, absence of diabetic retinopathy by 57% of respondents, short diabetes duration by 65% of respondents, rapid GFR decline by 75% of respondents and hematuria by 78% of respondents. These data highlight the high diversity of opinions on this topic and their discrepancies with guidelines and current literature regarding the association between non-diabetic renal disease and clinical and biological features. The lack of adhesion of nephrologists to guidelines was especially noteworthy regarding the absence of diabetic retinopathy. These results emphasize the need for studies focusing on biopsy indication criteria in patients with type 2 diabetes.

Mots clés: Proteinuria; Poll; Diabetic nephropathy; Renal biopsy; Type 2 diabetes

Mots clés: Protéinurie; Biopsie rénale; Diabète de type 2; Enquête d’opinion; Néphropathie diabétique

Domaines: Sciences du Vivant [q-bio]; Urologie et Néphrologie

Jonathan Maurice Chemouny, Aurélie Sannier, Guillaume Hanouna, Quentin Raimbourg, Eric Daugas, et al.. Critères d’indications de la biopsie rénale chez les patients diabétiques de type 2 protéinuriques : enquête auprès des néphrologues français. Néphrologie & Thérapeutique, 2019, 15 (7), pp.524-531. ⟨10.1016/j.nephro.2019.05.004⟩. ⟨hal-02396569⟩