Aprotinin induced lipohypertrophy and glomerulonephritis in an insulin dependent diabetic.
In an insulin dependent diabetic who was hyperglycaemic and ketotic despite 3,000 u of insulin injected subcutaneously in 2 divided doses daily, 50 u of intravenous insulin infused over 24 hr restored normal glucose homeostasis. A combination of insulin (800 u) and aprotinin (10,000 u) given twice daily also produced adequate glucose homeostasis for a period of 12 months. The patient then developed local hypertrophy of subcutaneous tissue at the injection site and her diabetic control deteriorated. Non-selective proteinuria followed and she developed nephrotic syndrome. Renal biopsy revealed a membraneous glomerulonephritis with subepithelial immune complexes, appearances consistent with a drug-induced glomerulonephritis. Withdrawal of aprotinin led to a gradual remission of nephrotic syndrome and proteinuria over several months. During this period, her diabetes was well controlled with continuous subcutaneous infusion of insulin at a dose of 500 u/24 hr. This case report demonstrates: the effective use of aprotinin for prolonged periods in insulin dependent diabetics with abnormal absorption of subcutaneously injected insulin; aprotinin induced lipohypertrophy which was not observed when insulin was injected alone; aprotinin-associated glomerulonephritis and nephrotic syndrome; the effective use of CSII--at higher insulin doses--in such patients with subcutaneous malabsorption of insulin.
Dandona
P
P
Mier
A
A
Boag
F
F
Chappell
M
M
Beckett
A G
AG
D000273:Adipose Tissue / Q000473:pathology*; D000293:Adolescent; D007611:Aprotinin / Q000008:administration & dosage / Q000009:adverse effects*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005921:Glomerulonephritis / Q000139:chemically induced*; D006801:Humans; D006984:Hypertrophy; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage; D007333:Insulin Resistance; D013848:Thigh
D007328:Insulin; D007611:Aprotinin