Stable renal function in insulin-dependent diabetes mellitus 10 years after nephrotic range proteinuria.
It has been considered unlikely that patients with insulin-dependent diabetes and diabetic nephropathy with nephrotic range proteinuria can substantially reduce proteinuria and continue for many years without further loss of renal function. We present a patient who had the diagnosis of insulin-dependent diabetes made at age 15, had his first of 6 laser treatments for proliferative and hemorrhagic retinopathy at age 27 and was found to have nephrotic range proteinuria and edema with hypertension at age 29, when results of a renal biopsy were typical of diabetic nephropathy. Ten years later, with the last 5.5 years on ACE inhibitors, proteinuria has been < 0.65 g/24 h for 2 years and recently 0.22 g, serum creatinine is unchanged at 90 to 102 mu mol/l, DTPA GFR is 104 ml/min and retinopathy has remained stable without laser therapy for 7 years. Blood pressure on clinic visits has averaged 126/74 for the last 8 years. This duration of stable renal function and the major decrease in proteinuria after being in the neprotic range is very rare in reports, if not unique.
Memorial University, St. John's, NF, Canada.
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Gault
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Fernandez
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D001806:Blood Urea Nitrogen; D002318:Cardiovascular Diseases / Q000378:metabolism; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000378:metabolism*; D003928:Diabetic Nephropathies / Q000378:metabolism*; D003930:Diabetic Retinopathy / Q000378:metabolism; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007678:Kidney Glomerulus / Q000166:cytology / Q000648:ultrastructure; D008297:Male; D008854:Microscopy, Electron; D011507:Proteinuria / Q000378:metabolism*; D012709:Serum Albumin / Q000032:analysis
D001786:Blood Glucose; D006454:Hemoglobins; D012709:Serum Albumin; D003404:Creatinine