Background: Worldwide, diabetic nephropathy-DN is the leading cause of end-stage kidney disease-ESKD, DN is a common cause of renal failure with a reported frequency of 10% - 15% in type-2-diabetes-mellitus-T2DM patie...Background: Worldwide, diabetic nephropathy-DN is the leading cause of end-stage kidney disease-ESKD, DN is a common cause of renal failure with a reported frequency of 10% - 15% in type-2-diabetes-mellitus-T2DM patients, however there is a great discrepancy between countries. The aim of the pre-sent study is to evaluate the findings of kidney biopsies performed on diabetic patients. Materials and Methods: We studied native kidney histopathological findings in the period from January 2016 till end of December 2018 done for patients with T2DM with chronic kidney diseases-CKD. Results: A total of 82 DM-patients, 50 males (61%) and 32 females (39%) with age mean (95% CI) of 50.8 (47.1 - 55.2) years for all patients, ranged between 15 to 65 years. Histological findings showed that 57.3% of patients had DN. While focal-segmental-glomerulosclerosis-FSGS was present in 20.7%—primary in 8.6% and secondary in 12.1%. IgA represented 4.9%, while Lupus nephritis, Membranous and drug induced interstitial nephritis were each present in 3.7%. MCD was present in 2.4%. Lastly diffuse proliferative GN, ANCA associated glomerulonephritis, and hypertensive nephrosclerosis accounted for 1.2%. Conclusion: The prevalence of NDKD is remarkably frequent in DM patients who underwent kidney biopsy and FSGS was the most frequent diagnosis. To get a proper histopathological diagnosis, an adequate tissue biopsy is needed with an adequate number of glomeruli. There is a great need for more consideration to biopsy diabetic patients, as the finding of NDKD requires a different therapeutic approach. This, hopefully, will help to manage these patients better and therefore, ameliorate the progression to ESKD over time and therefore delay the need for RRT.展开更多
End-Stage Renal Disease (ESRD) represents one of the most challenging social and medical problems mainly due to substantial treatment-associated costs. The chronic nature of the disease needs expensive continuous care...End-Stage Renal Disease (ESRD) represents one of the most challenging social and medical problems mainly due to substantial treatment-associated costs. The chronic nature of the disease needs expensive continuous care that majority of the patients cannot afford. Therefore, in many countries expenses associated with the ESRD treatment is paid by state government. These treatment options include: hemodialysis, peritoneal dialysis and kidney transplantation. Multiple studies have been conducted throughout the world to assess cost-effectiveness of these treatment modalities. The studies suggest that kidney transplantation not only reduces mortality and morbidity but improves a quality of life of ESRD patients. Furthermore, it is the most cost-effective treatment for the ESRD at least in high-income countries. The goal of our study was to determine whether above-mentioned is true for lower middle income countries, where the cost of the ESRD treatment is substantially lower. Despite the low dialysis costs, transplantation remains the cheapest form of renal replacement therapy RRT in lower income countries like Georgia. Our results reveal, that kidney transplantation is most expensive modality of Renal Replacement Therapy (RRT) at month 1, but count of costs reveals that after the 10th month of treatment, the cumulative cost of transplantation is less than the cumulative cost of peritoneal dialysis and after the 23<sup>rd</sup> month, cumulative cost of hemodialysis also surpasses the cumulative cost of transplantation-related treatment and this cost comparison is in line with global data from upper-middle and high income countries.展开更多
文摘Background: Worldwide, diabetic nephropathy-DN is the leading cause of end-stage kidney disease-ESKD, DN is a common cause of renal failure with a reported frequency of 10% - 15% in type-2-diabetes-mellitus-T2DM patients, however there is a great discrepancy between countries. The aim of the pre-sent study is to evaluate the findings of kidney biopsies performed on diabetic patients. Materials and Methods: We studied native kidney histopathological findings in the period from January 2016 till end of December 2018 done for patients with T2DM with chronic kidney diseases-CKD. Results: A total of 82 DM-patients, 50 males (61%) and 32 females (39%) with age mean (95% CI) of 50.8 (47.1 - 55.2) years for all patients, ranged between 15 to 65 years. Histological findings showed that 57.3% of patients had DN. While focal-segmental-glomerulosclerosis-FSGS was present in 20.7%—primary in 8.6% and secondary in 12.1%. IgA represented 4.9%, while Lupus nephritis, Membranous and drug induced interstitial nephritis were each present in 3.7%. MCD was present in 2.4%. Lastly diffuse proliferative GN, ANCA associated glomerulonephritis, and hypertensive nephrosclerosis accounted for 1.2%. Conclusion: The prevalence of NDKD is remarkably frequent in DM patients who underwent kidney biopsy and FSGS was the most frequent diagnosis. To get a proper histopathological diagnosis, an adequate tissue biopsy is needed with an adequate number of glomeruli. There is a great need for more consideration to biopsy diabetic patients, as the finding of NDKD requires a different therapeutic approach. This, hopefully, will help to manage these patients better and therefore, ameliorate the progression to ESKD over time and therefore delay the need for RRT.
文摘End-Stage Renal Disease (ESRD) represents one of the most challenging social and medical problems mainly due to substantial treatment-associated costs. The chronic nature of the disease needs expensive continuous care that majority of the patients cannot afford. Therefore, in many countries expenses associated with the ESRD treatment is paid by state government. These treatment options include: hemodialysis, peritoneal dialysis and kidney transplantation. Multiple studies have been conducted throughout the world to assess cost-effectiveness of these treatment modalities. The studies suggest that kidney transplantation not only reduces mortality and morbidity but improves a quality of life of ESRD patients. Furthermore, it is the most cost-effective treatment for the ESRD at least in high-income countries. The goal of our study was to determine whether above-mentioned is true for lower middle income countries, where the cost of the ESRD treatment is substantially lower. Despite the low dialysis costs, transplantation remains the cheapest form of renal replacement therapy RRT in lower income countries like Georgia. Our results reveal, that kidney transplantation is most expensive modality of Renal Replacement Therapy (RRT) at month 1, but count of costs reveals that after the 10th month of treatment, the cumulative cost of transplantation is less than the cumulative cost of peritoneal dialysis and after the 23<sup>rd</sup> month, cumulative cost of hemodialysis also surpasses the cumulative cost of transplantation-related treatment and this cost comparison is in line with global data from upper-middle and high income countries.
