Reversible acute renal failure and nephrotic syndrome in a Type 1 diabetic patient.
Nephrotic syndrome is a condition commonly associated with end-stage renal disease secondary to diabetic nephropathy. It is usually associated with long-standing renal insufficiency, microalbuminuria, and overt proteinuria. We present a diabetic patient with acute oliguric renal failure and nephrotic syndrome. At presentation, he had a serum creatinine of 2.3 mg/dl, blood urea nitrogen (BUN) of 69 mg/dl, urinary protein excretion of 10.5 g/24 h, serum albumin of 1.3 g/dl, and a urine output < 400 cc/24 h. A renal biopsy was done and the renal pathology was compatible with early diabetic nephropathy. Despite intense diuretic therapy, the patient's renal condition did not improve, and peritoneal dialysis was started several months after diagnosis. After 8 months of dialysis therapy, the patient's renal parameters and urinary output spontaneously restored to normal limits (serum creatinine was 1.1 mg/dl, urinary albumin excretion was 411 mg/24 h, serum albumin was 4.3 g/dl, and normal urine output) and dialysis was discontinued. His renal function did not deteriorate after discontinuation of dialysis. We conclude that this patient's reversible acute renal failure and nephrotic syndrome were associated with minimal change disease and not due to diabetic nephropathy.
Avilés-Santa
Larissa
L
Division of Clinical Diabetes, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, G5.238,Dallas, TX 75390-8858, USA.
Alpern
Robert
R
Raskin
Philip
P
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D000328:Adult; D001806:Blood Urea Nitrogen; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000473:pathology; D003928:Diabetic Nephropathies / Q000473:pathology*; D018450:Disease Progression; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use*; D004487:Edema; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009404:Nephrotic Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D014554:Urination
D004232:Diuretics; D005665:Furosemide