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.
Gault
M H
MH
Memorial University, St. John's, NF, Canada.
Fernandez
D
D
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