Diabetic Nephropathy in People With Diabetes. Prevalence and Predictive Factors

Inclusion criteria

• Age ≥ 18 years
• Written informed consent
• Diagnosis with T2DM according to the American diabetes Association (20)
• eGFR \>30 mL/min/1.73 m2 (maximum six months old)
• urine-albumin/creatinine-ratio (uACR) \> 700 mg/g or 24 hours urine albumin \>700 mg on more than one measurement

Exclusion criteria

• Signs of acute kidney failure according to the KDIGO classification (21) at the time for kidney biopsy or the last 6 months before kidney biopsy
• Factors that increases the risk of complications due to kidney biopsy:
• Hemoglobin \< 6 mmol/L
• INR \>1,4 at the time for biopsy
• Platelet count \< 100 x 109/l
• Uncontrolled high blood pressure (defined as systolic blood pressure \> 160 mmHg and/or diastolic blood pressure \> 100 mmHg)
• Only one functioning kidney
• Evidence of urinary tract obstruction or hydronephrosis at the time of biopsy
• Multiple bilateral kidney cysts
• Kidney infection, peri-renal infection, or cutaneous infection that overlies the kidney at time for biopsy
• Unwilling to receive blood transfusion
• Unable to lie flat in bed six hours after biopsy
• Any other contra-indications for percutaneous kidney biopsy according to local clinical guidelines
• Unable to understand written and oral information
• Kidney transplant recipient
• Previous medical kidney biopsy
• Women who are pregnant or planning to become pregnant before the kidney biopsy is performed
• Treatment with Marcoumar (all other anticoagulants are accepted)
• High thromboembolic risk combined with held in anticoagulation therapy according to the report "Perioperative regulation of antithrombotic treatment" (PRAB) (22)
• mechanical heart valve
• atrial fibrillation AND CHA2DS2-VASc\> 5 and/or stroke within the last three months
• recurrent venous thromboembolism OR venous thromboembolism within the last three months
• less than 6 weeks after uncomplicated Acute Coronary Syndrome (ACS) with or without revascularization (Percutaneous Coronary Intervention (PCI)) with Bare Metal Stents (BMS) or Coronary Artery Bypass Grafting (CABG))
• less than 3 months after uncomplicated ACS with revascularization (PCI with Drug Eluting Stent (DES))
• less than 9-12 months after complicated ACS (e.g. reinfarction or stent thrombosis)
• less than 1 month after revascularization in individuals with stable Coronary Artery Disease (CAD) (PCI with BMS or CABG)
• less than 3 months after revascularization in individuals with stable CAD (PCI with DES)
• less than 3 months after stroke, or Transient Ischemic Attack (TIA)
• Inability to withdraw nonsteroidal anti-inflammatory drugs (NSAID) 7 days before biopsy
• If a participant meets one or more exclusion criteria, that are reversible, the participant can be rescreened later on, to evaluate whether or not the participant now is qualified for participation.