Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026
Clinical phenotype and prognosis of patients with diabetic kidney disease complicated by a primary podocytopathy.
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Zhou Yue, Wang Hui, Nie Lin, Zhao Ming-Hui, Wang Su-Xia
Аннотация
BACKGROUND: Diabetic nephropathy (DN), a leading cause of end-stage kidney disease (ESKD), often progresses despite standard care. Evidence suggests a DN subgroup exhibiting overlapping features of primary podocytopathy, potentially responsive to immunosuppression, that has not yet been systematically studied. We hypothesized that DN patients with biopsy-proven concurrent ultrastructural features of primary podocytopathy will demonstrate superior renal outcomes following immunosuppressive therapy, compared with those with isolated DN pathology.
METHODS: A retrospective analysis was conducted on 88 patients with biopsy-confirmed DN recruited from Peking University First Hospital between 2017 and 2022. The patients were categorized into two groups: Group A (patients with DN and primary podocytopathy) and Group B (patients with DN without primary podocytopathy). Seven patients with diabetes and primary podocytopathy but without DN served as disease controls. Primary podocytopathy was defined by electron microscopy foot process width (FPW) ≥821 nm.
RESULTS: Patients in Group A had a shorter duration of nephropathy (P = .005), lower serum albumin levels (P < .001) and higher proteinuria (P = .032) than those in Group B. Light microscopy demonstrated milder glomerular lesions in Group A (P < .001), with most cases classified as Class I or II (63.6%). Electron microscopy showed significantly broader FPW in Group A than in Group B (1310.5 ± 510.1 nm vs 569.1 ± 97.5 nm, P < .001). While Group B showed no such benefit and differed significantly from the control group, patients in Group A benefited from immunosuppressive therapy, with a significantly reduced risk of ESKD.
CONCLUSION: DN with concurrent primary podocytopathy represents a distinct clinical entity characterized by nephrotic-range proteinuria, ultrastructural podocyte effacement and favorable response to immunosuppressive therapy. Early renal biopsy incorporating FPW assessment enables targeted therapy to mitigate ESKD progression in this high-risk phenotype.
METHODS: A retrospective analysis was conducted on 88 patients with biopsy-confirmed DN recruited from Peking University First Hospital between 2017 and 2022. The patients were categorized into two groups: Group A (patients with DN and primary podocytopathy) and Group B (patients with DN without primary podocytopathy). Seven patients with diabetes and primary podocytopathy but without DN served as disease controls. Primary podocytopathy was defined by electron microscopy foot process width (FPW) ≥821 nm.
RESULTS: Patients in Group A had a shorter duration of nephropathy (P = .005), lower serum albumin levels (P < .001) and higher proteinuria (P = .032) than those in Group B. Light microscopy demonstrated milder glomerular lesions in Group A (P < .001), with most cases classified as Class I or II (63.6%). Electron microscopy showed significantly broader FPW in Group A than in Group B (1310.5 ± 510.1 nm vs 569.1 ± 97.5 nm, P < .001). While Group B showed no such benefit and differed significantly from the control group, patients in Group A benefited from immunosuppressive therapy, with a significantly reduced risk of ESKD.
CONCLUSION: DN with concurrent primary podocytopathy represents a distinct clinical entity characterized by nephrotic-range proteinuria, ultrastructural podocyte effacement and favorable response to immunosuppressive therapy. Early renal biopsy incorporating FPW assessment enables targeted therapy to mitigate ESKD progression in this high-risk phenotype.