Kidney biopsy teaching caseARF in 2 patients with long-standing type 2 diabetes mellitus
Section snippets
Patient 1
A 56-year-old Chinese man had a 10-year history of poorly controlled insulin-dependent type 2 DM. In July 2003, hemoglobin A1c level was 9.8% (good control range, 6.5% to 7.9%), and diabetic complications included gastroparesis, nonproliferative retinopathy, and microalbuminuria. He also had a history of gastritis, hypertension, and hypercholesterolemia. His medications included insulin twice daily, enalapril, and atorvastatin. In July 2003, he had a urine microalbumin concentration of 258 mg/L.
Discussion
We present 2 cases of crescentic GN superimposed on DN. Both patients had long-standing type 2 DM with close-to-normal serum creatinine levels before their current illness. They presented with rapid deterioration in renal function associated with active urinary sediment. Renal biopsy specimens in both patients showed crescentic GN. On immunofluorescence, one case was pauci-immune, but showed weak linear PCW staining for IgG and albumin, consistent with diabetes. This patient had an elevated
References (14)
- et al.
Nondiabetic renal disease in patients with diabetes mellitus
Am J Med
(1983) - et al.
End-stage renal failure in type 2 diabetesA medical catastrophe of worldwide dimensions
Am J Kidney Dis
(1999) - et al.
Goodpasture’s disease in the absence of circulating anti-glomerular basement membrane antibodies as detected by standard techniques
Am J Kidney Dis
(2002) - et al.
Pattern of double glomerulopathiesA clinicopathologic study of superimposed glomerulonephritis on diabetic glomerulosclerosis
Mod Pathol
(1989) - et al.
Increased prevalence of renal biopsy findings other than diabetic glomerulopathy in type II diabetes mellitus
Nephrol Dial Transplant
(1992) - et al.
Prospective study on renal outcome of IgA nephropathy superimposed on diabetic glomerulosclerosis in type 2 diabetic patients
Nephrol Dial Transplant
(2001) - et al.
Diabetes mellitus associated with rapidly progressive glomerulonephritis with perinuclear antineutrophil cytoplasmic antibodies
Intern Med
(2001)
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Diabetic nephropathy
2011, Diabeto-AngiologyPauci-immune crescentic glomerulonephritis superimposed on diabetic glomerulosclerosis
2008, Clinical Journal of the American Society of Nephrology
Originally published online as doi:10.1053/j.ajkd.2004.07.025 on December 27, 2004.