Dr RIZZA ANTOINETTE YAP SO-RUBIO1, Dr Susan Wan1, Dr Amanda Siriwardana1, Dr Emma O’Lone1,3, Dr Amanda Mather1, Dr Carol Pollock1, Dr Brendon Neuen1,2
1Royal North Shore Hospital, ST LEONARDS, Australia, 2The George Institute for Global Health, University of New South Wales, Sydney, Australia, 3University of Sydney, Camperdown, Australia
Biography:
Dr. So trained in General Nephrology at the Royal North Shore Hospital (RNSH) in 2023 as an International Society of Nephrology Fellow. In 2024, she took on the role of Unaccredited Trainee in Research, focusing on vascular access surveillance and maintenance. She worked on various research projects in the same field during this time. She has since returned to the Philippines and has applied for a staff specialist position at the National Kidney and Transplant Institute (NKTI). Dr. So is eager to apply all the knowledge and experience she gained abroad and looks forward to future collaborative work with RNSH.
Aim:
To (1) describe the indications for kidney biopsy in patients with diabetes, (2) determine the incidence of non-diabetic and mixed pathologies in this population, and (3) assess how frequently biopsy findings altered clinical management.
Background:
Given its high prevalence, diabetes is often assumed to be the primary cause of chronic kidney disease (CKD); however, other pathologies may coexist or be misattributed. Contemporaneous Australian data on non-diabetic kidney disease in individuals with diabetes are limited.
Methods: We conducted a retrospective observational cohort study of all native kidney biopsies performed on adult patients at a single metropolitan hospital between 1 January 2017 and 31 December 2023. Data were extracted from a dedicated quality assurance and clinical database and included patient demographics, clinical features, biopsy indications, histopathological diagnoses, and subsequent changes in management.
Results:
Of 479 patients who underwent native kidney biopsy during the study period, 84 (18%) had diabetes. The most common indications for biopsy in these patients were active urinary sediments [40, 48%], nephrotic-range proteinuria [36, 43%], and progressive CKD [34, 41%]. Non-diabetic and mixed pathology were identified in 41 (49%) and 18 (21%) of cases, respectively, with the most frequent diagnoses being IgA nephropathy, acute tubular necrosis, and acute interstitial nephritis. Biopsy findings led to a change in clinical management in 19 (23%) cases.
Conclusions:
Kidney biopsy in selected patients with diabetes reveals a significant proportion of non-diabetic or mixed pathologies, underscoring the value of kidney biopsies in guiding diagnosis, prognosis, and management in this population.
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