title: Complete reversal of the nephrotic syndrome after preemptive pancreas-kidney transplantation: a case report.
abstract: BACKGROUND
  Nephrotic syndrome due to diabetic nephropathy is presently considered an indication for pancreas-kidney transplantation even in the absence of severe renal failure. Reversal of the nephrotic syndrome has been reported, but the mechanisms of this effect are unclear.
  
  
  OBJECTIVE
  To describe the renal morphofunctional pattern and the pattern of proteinuria before and after preemptive pancreas-kidney transplantation.
  
  
  METHODS
  Methods included quantitative and qualitative assessment of proteinuria as well as renal ultrasound and scintiscan.
  
  
  METHODS
  A 42-year-old woman with type 1 diabetes since age 24 had widespread end-organ damage. Renal biopsy (2001) showed a mainly nodular pattern of diabetic nephropathy. Following referral (1999), her serum creatinine ranged from 1.6 to 2.2 mg/dL, with nephrotic range proteinuria (glomerular nonselective, tubular complete). Renal scintiscan revealed bilateral, symmetric, well-perfused kidneys. The functional data before pancreas-kidney graft (February 2003) were: serum creatinine 1.6 mg/dL, creatinine clearance 58 mL/min, serum albumin 2.6 g/dL, proteinuria 9.1 g/d. At hospital discharge (March 2003), the creatinine was 1.2 mg/dL, the creatinine clearance 97 mL/min, the proteinuria 0.676 g/d. Two months later, the creatinine was 1.2 mg/dL and proteinuria 0.421 g/d. A renal scintiscan demonstrated the functional prevalence of the grafted kidney (77% of total function), with vital, almost completely excluded native kidneys (functional contribution, 11.5% each). Proteinuria, ranging from 0.3 to 0.6 g/d, showed a physiological pattern.
  
  
  CONCLUSIONS
  Functional exclusion of the native kidneys by renal scintiscan gives morphological support to reversal of the nephrotic syndrome.
authors.affiliation: Cattedra di Nefrologia, Department of Internal Medicine, University of Torino, Torino, Italy. gbpiccoli@yahoo.it
authors.forename: G B
authors.initials: GB
authors.lastname: Piccoli
authors.forename: M
authors.initials: M
authors.lastname: Rossetti
authors.forename: P
authors.initials: P
authors.lastname: Marchetti
authors.forename: G
authors.initials: G
authors.lastname: Grassi
authors.forename: G
authors.initials: G
authors.lastname: Picciotto
authors.forename: M
authors.initials: M
authors.lastname: Barsotti
authors.forename: F
authors.initials: F
authors.lastname: Vistoli
authors.forename: M
authors.initials: M
authors.lastname: Burdese
authors.forename: A
authors.initials: A
authors.lastname: Sargiotto
authors.forename: E
authors.initials: E
authors.lastname: Mezza
authors.forename: G
authors.initials: G
authors.lastname: Soragna
authors.forename: F
authors.initials: F
authors.lastname: Bermond
authors.forename: M
authors.initials: M
authors.lastname: Gai
authors.forename: D
authors.initials: D
authors.lastname: Motta
authors.forename: G
authors.initials: G
authors.lastname: Lanfranco
authors.forename: F
authors.initials: F
authors.lastname: Dani
authors.forename: A
authors.initials: A
authors.lastname: Jeantet
authors.forename: U
authors.initials: U
authors.lastname: Boggi
authors.forename: G P
authors.initials: GP
authors.lastname: Segoloni
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery*; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000379:methods* / Q000502:physiology; D009404:Nephrotic Syndrome / Q000601:surgery*; D016035:Pancreas Transplantation / Q000379:methods* / Q000502:physiology; D016896:Treatment Outcome