Kidney biopsy teaching case
ARF in 2 patients with long-standing type 2 diabetes mellitus

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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

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Originally published online as doi:10.1053/j.ajkd.2004.07.025 on December 27, 2004.

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