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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#58;</span></p><p class="elsevierStylePara">The prevalence of diabetes mellitus &#40;DM&#41; has increased globally&#44; primarily type 2&#46;<span class="elsevierStyleSup">1</span> One of the main complications of this disease&#44; diabetic nephropathy &#40;DN&#41;&#44; is the primary global cause of terminal chronic kidney disease &#40;TCKD&#41;&#44; and affects approximately one-third of all DM patients&#46;<span class="elsevierStyleSup">2</span> The diagnosis of this condition is usually established based on clinical criteria in diabetic patients with albuminuria and&#47;or diabetic retinopathy&#46;</p><p class="elsevierStylePara">However&#44; it is also common to encounter non-diabetic kidney disease in diabetic patients&#44; which necessitates the indication for renal biopsies in patients with DM and nephropathy&#44; especially those with a rapid progression or atypical forms of disease&#46;<span class="elsevierStyleSup">2&#44;3</span></p><p class="elsevierStylePara">In our study&#44; we describe the characteristics of patients with DN confirmed by renal biopsy&#46; We analysed the motives described for indicating the renal biopsy and the moment in the evolution of disease when the biopsy was taken&#46;</p><p class="elsevierStylePara">During the study period of 2004-2011&#44; a total of 156 native renal biopsies were performed at the Hospital General de Segovia&#46; In 17 of these &#40;10&#46;9&#37;&#41;&#44; a final diagnosis of DN was made&#46;</p><p class="elsevierStylePara">Table 1 describes the socio-demographic characteristics&#44; pathological history&#44; treatments given&#44; and laboratory results for all of these patients prior to the renal biopsy&#46;</p><p class="elsevierStylePara">As regards the motive for indicating the renal biopsy&#44; 82&#46;4&#37; of cases were due to nephrotic range proteinuria or nephrotic syndrome&#44; 5&#46;9&#37; were due to acute renal failure&#44; another 5&#46;9&#37; were due to persistent urinary alterations&#44; and the final 5&#46;9&#37; were due to other indications&#46; In 16 patients&#44; the diagnosis was established based on the first renal biopsy&#44; and the other patient required a second biopsy to confirm the diagnosis&#46;</p><p class="elsevierStylePara">In two patients&#44; the diagnosis of DN was confirmed when the patient had TCKD&#44; while on a dialysis programme&#46;</p><p class="elsevierStylePara">Lin et al&#46; performed a retrospective analysis of 50 renal biopsies in patients with type 2 DM&#44; showing that in patients with type 2 DM of at least 10 years evolution and retinopathy&#44; the presence of non-diabetic kidney disease cannot be ruled out&#46; In their study&#44; elevated serum albumin levels and low urinary protein losses served as indications for renal biopsies in order to exclude the possibility of non-diabetic kidney disease&#46;<span class="elsevierStyleSup">4</span> In our study however&#44; the primary motive for indicating renal biopsy was severe&#44; persistent&#44; or increasing proteinuria in patients that had already been treated with anti-proteinuric drugs&#44; in which the diagnosis of DN was confirmed&#46;</p><p class="elsevierStylePara">To conclude&#44; our patients with DN as confirmed by renal biopsy had nephrotic range nephropathy or severe nephrotic syndrome&#44; with DM of long evolution and associated with poor metabolic control&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors state that they have no potential conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><a href="grande&#47;11623&#95;108&#95;39767&#95;en&#95;t1&#46;6&#46;jpg" class="elsevierStyleCrossRefs"><img src="11623_108_39767_en_t1.6.jpg" alt="Sociodemographic characteristics&#44; pathological history&#44; laboratory results&#44; and treatments given prior to renal biopsy"></img></a></p><p class="elsevierStylePara">Table 1&#46; Sociodemographic characteristics&#44; pathological history&#44; laboratory results&#44; and treatments given prior to renal biopsy</p>"
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                  "referenciaCompleta" => "Ritz E, Zeng XX, Rychlik I. Clinical manifestation and natural history of diabetic nephropathy. Contrib Nephrol 2011;170:19-27. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21659754" target="_blank">[Pubmed]</a>"
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