Innsbruck Diabetic Kidney Disease Cohort

Chronic kidney disease (CKD) occurs in about one third of type II diabetic patients and significantly increases the risk of cardiovascular disease and death. In the presence of long diabetes duration, slowly declining kidney function over several years and diabetic retinopathy, the diagnosis diabetic kidney disease is usually made without confirmation by kidney biopsy. However, recent scientific findings indicate that CKD in type II diabetics is not a uniform disease and that the type and extent of kidney damage significantly differs among these patients, which is most likely relevant for individual prognosis and therapy. Since kidney biopsy is currently reserved for atypical disease courses only, the underlying type of kidney damage is inadequately known in the majority of type II diabetic patients with typical disease course. As clinical parameters alone do not appropriately reflect the underlying kidney pathology, the reluctance regarding timely bioptic assessment in type II diabetic CKD patients has to be critically questioned. Within the Innsbruck Diabetic Kidney Disease Cohort (IDKDC) study, type II diabetics with early stages CKD and a typical clinical disease course are subjected to a currently not routinely performed - diagnostic kidney biopsy and followed up clinically over several years. The study aims to determine both the frequency and clinical disease course of different kidney damage patterns (typical diabetic vs. atypical/mixed vs. non-diabetic) for the first time in type II diabetic CKD patients. While current risk assessment is primarily based on clinical parameters, the present study will clarify the role of a diagnostic kidney biopsy for individual risk prediction regarding need for dialysis, cardiovascular diseases and death. Furthermore, tissue, blood and urine samples will be continuously collected to identify so-called biomarkers by using state-of-the-art laboratory methodology, which could foster prediction of CKD etiology, course and therapeutic response. This FWF-funded clinical study will provide the scientific background for a potential change of the current diagnostic standard towards routine kidney biopsy in type II diabetic CKD patients and help to establish "precision medicine" approaches among this vulnerable group of patients.