---
title: "Predicting Non-Diabetic Glomerular Disease in Type 2 Diabetes with Nephrotic‑Range Proteinuria"
id: "pubmed-42670193"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42670193"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42670193/"
doi: "10.1111/nep.70275"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Predicting Non-Diabetic Glomerular Disease in Type 2 Diabetes with Nephrotic‑Range Proteinuria
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42670193
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42670193/)
- **DOI:** [10.1111/nep.70275](https://doi.org/10.1111%2Fnep.70275)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Aim: Determine clinical predictors of **non‑diabetic glomerular disease (NDGD)** among Type 2 diabetes mellitus (T2DM) patients presenting with **nephrotic‑range proteinuria** and derive a simple score to guide biopsy selection. - Design: Single‑center retrospective study of native kidney biopsies performed for nephrotic‑range proteinuria at a tertiary hospital in Thailand from 2014–2022. - Cohort: 289 T2DM patients who underwent native kidney biopsy for nephrotic‑range proteinuria. - Prevalence: NDGD was present in 142 patients (49.1%), either alone or with concomitant diabetic nephropathy; the most frequent histologic diagnosis was **IgA nephropathy**. - Independent clinical predictors retained in multivariable analysis: older age, shorter duration of T2DM, absence of diabetic retinopathy, absence of prior hypertension, higher estimated glomerular filtration rate (eGFR), and hematuria. Higher hemoglobin was included in the model despite borderline statistical association. - Prediction score: A weighted clinical score was derived from the independent predictors to estimate likelihood of NDGD. - Discrimination: The score performed well with an **AUROC** of 0.85 (95% CI 0.80–0.89). - Threshold performance examples: score ≥ 3 yielded 96.5% sensitivity and 40.8% specificity; score ≥ 7 yielded 66.9% sensitivity and 84.4% specificity. - Conclusion: NDGD is common in T2DM patients with nephrotic‑range proteinuria. The proposed clinical prediction score shows good discrimination in this cohort but requires external validation before clinical use for biopsy decision‑making. - Limitations noted in source: single‑center retrospective design and the authors recommend external validation prior to implementation.
## Clinical Analysis & Structured Key Points
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Clinical Predictors of Non-Diabetic Glomerular Disease in Type 2 Diabetic Patients With Nephrotic-Range Proteinuria [Sittipath Tirasattayapitak](https://pubmed.ncbi.nlm.nih.gov/?term=Tirasattayapitak+S&cauthor_id=42670193)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-1 "Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand."), [Kanin Thammavaranucupt](https://pubmed.ncbi.nlm.nih.gov/?term=Thammavaranucupt+K&cauthor_id=42670193)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-2 "Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand."), [Kavee Limbutara](https://pubmed.ncbi.nlm.nih.gov/?term=Limbutara+K&cauthor_id=42670193)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-1 "Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-3 "Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand."), [Nitcha Suphatheerawatr](https://pubmed.ncbi.nlm.nih.gov/?term=Suphatheerawatr+N&cauthor_id=42670193)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-1 "Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-3 "Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand."), [Wanjak Pongsittisak](https://pubmed.ncbi.nlm.nih.gov/?term=Pongsittisak+W&cauthor_id=42670193)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-1 "Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-3 "Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand."), [Chutima Chavanisakun](https://pubmed.ncbi.nlm.nih.gov/?term=Chavanisakun+C&cauthor_id=42670193)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-4 "Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand."), [Nontawat Benjakul](https://pubmed.ncbi.nlm.nih.gov/?term=Benjakul+N&cauthor_id=42670193)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-4 "Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand."), [Solos Jaturapisanukul](https://pubmed.ncbi.nlm.nih.gov/?term=Jaturapisanukul+S&cauthor_id=42670193)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-1 "Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#full-view-affiliation-3 "Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand.") Affiliations Expand ### Affiliations * 1 Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. * 2 Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand. * 3 Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand. * 4 Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. * PMID: **42670193** * DOI: [ 10.1111/nep.70275 ](https://doi.org/10.1111/nep.70275) Item in Clipboard # Clinical Predictors of Non-Diabetic Glomerular Disease in Type 2 Diabetic Patients With Nephrotic-Range Proteinuria Sittipath Tirasattayapitak et al. Nephrology (Carlton). 2026 Sep. Show details Display options Display options Format Abstract PubMed PMID Nephrology (Carlton) Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Nephrology+%28Carlton%29%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Nephrology+%28Carlton%29%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670193/) . 2026 Sep;31(9):e70275. doi: 10.1111/nep.70275. ### Authors [Sittipath Tirasattayapitak](https://pubmed.ncbi.nlm.nih.gov/?term=Tirasattayapitak+S&cauthor_id=42670193)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-1 "Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand."), [Kanin Thammavaranucupt](https://pubmed.ncbi.nlm.nih.gov/?term=Thammavaranucupt+K&cauthor_id=42670193)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-2 "Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand."), [Kavee Limbutara](https://pubmed.ncbi.nlm.nih.gov/?term=Limbutara+K&cauthor_id=42670193)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-1 "Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-3 "Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand."), [Nitcha Suphatheerawatr](https://pubmed.ncbi.nlm.nih.gov/?term=Suphatheerawatr+N&cauthor_id=42670193)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-1 "Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-3 "Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand."), [Wanjak Pongsittisak](https://pubmed.ncbi.nlm.nih.gov/?term=Pongsittisak+W&cauthor_id=42670193)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-1 "Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-3 "Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand."), [Chutima Chavanisakun](https://pubmed.ncbi.nlm.nih.gov/?term=Chavanisakun+C&cauthor_id=42670193)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-4 "Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand."), [Nontawat Benjakul](https://pubmed.ncbi.nlm.nih.gov/?term=Benjakul+N&cauthor_id=42670193)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-4 "Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand."), [Solos Jaturapisanukul](https://pubmed.ncbi.nlm.nih.gov/?term=Jaturapisanukul+S&cauthor_id=42670193)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-1 "Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42670193/#short-view-affiliation-3 "Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand.") ### Affiliations * 1 Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. * 2 Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand. * 3 Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand. * 4 Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. * PMID: **42670193** * DOI: [ 10.1111/nep.70275 ](https://doi.org/10.1111/nep.70275) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aim:** Nephrotic-range proteinuria in patients with Type 2 diabetes mellitus (T2DM) may result from diabetic nephropathy or non-diabetic glomerular disease (NDGD). Kidney biopsy risks and limited accessibility complicate patient selection. We aimed to identify predictors of NDGD and develop a score to guide biopsy decisions. **Methods:** We conducted a single-center retrospective study of T2DM patients undergoing native kidney biopsy for nephrotic-range proteinuria at a tertiary hospital in Thailand between 2014 and 2022. Biopsy findings were classified according to the presence or absence of NDGD. Independent predictors were identified using multivariable logistic regression, and a weighted clinical prediction score was derived. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUROC). **Results:** Among 289 patients, 142 (49.1%) had NDGD with or without concomitant DN. The most frequent diagnosis was IgA nephropathy. Independent predictors of NDGD included older age, shorter duration of T2DM, absence of diabetic retinopathy, absence of prior hypertension, higher estimated glomerular filtration rate, and hematuria. Higher haemoglobin was retained in the prediction model despite its borderline statistical association. The prediction score demonstrated good discrimination (AUROC, 0.85; 95% confidence interval, 0.80-0.89). At a threshold of ≥ 3 points, the score had 96.5% sensitivity and 40.8% specificity, whereas a threshold of ≥ 7 points had 66.9% sensitivity and 84.4% specificity. **Conclusion:** NDGD is common among T2DM patients with nephrotic-range proteinuria. The proposed clinical prediction score showed good discrimination in this cohort but requires external validation before it can be used to support biopsy decision-making in clinical practice. **Keywords:** Type 2; biopsy; diabetes mellitus; diabetic nephropathies; glomerulonephritis; nephrotic syndrome. © 2026 Asian Pacific Society of Nephrology. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Clinical significance of renal histological diagnosis in patients with type 2 diabetes and proteinuria atypical for diabetic nephropathy. ](https://pubmed.ncbi.nlm.nih.gov/41795127/) Kuwagata S, Chin-Kanasaki M, Yamada A, Sakae T, Ishimoto N, Imamura-Uehara Y, Yamahara K, Yasuda-Yamahara M, Sugahara S, Tanaka-Sasaki Y, Kuwata N, Nishimura K, Murata K, Miyazawa I, Ida S, Ohashi N, Kume S.Kuwagata S, et al.J Diabetes Investig. 2026 May;17(5):781-790. doi: 10.1111/jdi.70277. Epub 2026 Mar 7.J Diabetes Investig. 2026.PMID: 41795127Free PMC article. * [ Clinical predictors differentiating non-diabetic renal diseases from diabetic nephropathy in a large population of type 2 diabetes patients. ](https://pubmed.ncbi.nlm.nih.gov/27693840/) Dong Z, Wang Y, Qiu Q, Zhang X, Zhang L, Wu J, Wei R, Zhu H, Cai G, Sun X, Chen X.Dong Z, et al.Diabetes Res Clin Pract. 2016 Nov;121:112-118. doi: 10.1016/j.diabres.2016.09.005. Epub 2016 Sep 21.Diabetes Res Clin Pract. 2016.PMID: 27693840 * [ When to perform renal biopsy in patients with type2 diabetes mellitus? Predictive model of non-diabetic renal disease. ](https://pubmed.ncbi.nlm.nih.gov/31761446/) García-Martín F, González Monte E, Hernández Martínez E, Bada Boch T, Bustamante Jiménez NE, Praga Terente M.García-Martín F, et al.Nefrologia (Engl Ed). 2020 Mar-Apr;40(2):180-189. doi: 10.1016/j.nefro.2019.07.005. Epub 2019 Nov 21.Nefrologia (Engl Ed). 2020.PMID: 31761446English, Spanish. * [ [Renal histological lesions in patients with type II diabetes mellitus]. ](https://pubmed.ncbi.nlm.nih.gov/12085417/) Castellano I, Covarsí A, Novillo R, Gómez-Martino JR, Ferrando L.Castellano I, et al.Nefrologia. 2002;22(2):162-9.Nefrologia. 2002.PMID: 12085417Review.Spanish. * [ [Non-diabetic renal disease in type II diabetes mellitus]. ](https://pubmed.ncbi.nlm.nih.gov/12905620/) Li H, Li XW, Huang QY, Ye WL, Duan L, Li Y.Li H, et al.Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2003 Feb;25(1):101-4.Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2003.PMID: 12905620Review.Chinese. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42670193) ## References 1. 1. K. Umanath and J. B. Lewis, “Update on Diabetic Nephropathy: Core Curriculum 2018,” American Journal of Kidney Diseases 71, no. 6 (2018): 884–895, . 2. 1. K. Kim, S. H. Lee, S. W. Lee, J. P. Lee, and H. J. Chin, “Current Findings of Kidney Biopsy Including Nephropathy Associated With Hypertension and Diabetes Mellitus in Korea,” Korean Journal of Internal Medicine 35, no. 5 (2020): 1173–1187, . 3. 1. S. Shadab, P. Mittal, A. Barwad, et al., “Characterizing Predictors of Non‐Diabetic Kidney Disease (NDKD) in Diabetic Patients,” International Urology and Nephrology 54, no. 6 (2022): 1303–1309, [https://doi.org/10.1007/s11255‐021‐02998‐1](https://doi.org/10.1007/s11255%E2%80%90021%E2%80%9002998%E2%80%901). 4. 1. A. G. Kwon, H. Sawaf, G. Portalatin, et al., “Kidney Biopsy Findings Among Patients With Diabetes in the Cleveland Clinic Kidney Biopsy Epidemiology Project,” Kidney Medicine 6, no. 10 (2024): 100889, . 5. 1. K. Kritmetapak, S. Anutrakulchai, C. Pongchaiyakul, and A. Puapairoj, “Clinical and Patholog
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