4. Discussion
retinopathy, T2D, albuminuria, hepatitis B-associated glomerulonephritis, NDKD, glomerular hematuria, hematuria, nephropathy, renal injury, diabetes
DIABETIC RETINOPATHY, RETINOPATHY, SYSTEMIC DISEASE, IGA NEPHROPATHY, KIDNEY DISEASES, NEPHROTIC SYNDROME, TYPE 1 DIABETES, HEMATURIA, NEPHROPATHY, DIABETES
According to a previous systematic review, not all T2D patients undergoing renal puncture had DN, 40.6% had NDKD, and 18.1% had DN plus NDKD [In our study, hepatitis B-associated glomerulonephritis, drug-related renal injury, and other kidney diseases that were clinically easy to diagnose were excluded. However, there are still many NDKDs that are difficult to identify without renal biopsy, such as MN, IgA nephropathy, and ischemic nephropathy. In our study, NDKD accounted for 56.5% of the total population, and DN plus NDKD accounted for 17.3%, similar to previous reports.As previous studies have shown [In recent years, there have been intermittent studies on risk score models for DN diagnosis both domestically and internationally. Liu et al. [In our model, there were five variables categorized as 2 diabetes-related (diabetes duration and diabetic retinopathy) and 3 kidney-related (eGFR, 24 h UTP, and hematuria) items; these were all common indicators in clinical practice, even in most grassroots medical institutions. Our model score can be quickly calculated and ranked using simple manual methods. The model was verified internally and externally (spatially and temporally).In our model, patients in the low-risk group had a 6.5% to 15.1% probability of DN, patients in the medium-risk group had a 41.6% to 64.5% probability of DN, and patients in the high-risk group had an 81.9% to 100% probability of DN. For high-risk group patients, it may be possible to reduce the number of renal biopsies.All enrolled patients in our study were managed according to the latest guidelines during hospitalization. However, our study is a retrospective study with a wide time span. Since 2012, diabetes treatment drugs have also been updated. In recent years, with the application of kidney protective drugs such as sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and mineralocorticoid receptor antagonists (MRAs) in clinical practice in China, the cutoff point values of DN duration in our model may change. For the same reason, although the main indications for renal biopsy in T2D patients involved in our study were rapid onset or progression of albuminuria or sudden onset of nephrotic syndrome, rapid eGFR decline, glomerular hematuria, active urine sediment, suspicion of other systemic diseases, and patients with type 1 diabetes, short diabetes duration and absence of retinopathy, etc., these indicators may vary slightly with the update of guidelines and individual complex situations that may arise in clinical practice [In addition, Pafundi et al. [