Minimal change disease associated with type 1 and type 2 diabetes mellitus.
A 19-year-old female with type 1 diabetes for four years, and a 73-year-old female with type 2 diabetes for twenty years developed sudden-onset nephrotic syndrome. Examination by light microscopy, immunofluorescence, and electron microscopy (in one case) identified minimal change disease (MCD) in both cases. There was a potential causative drug (meloxicam) for the 73-year-old patient. Both patients were treated with prednisone and responded with complete remission. The patient with type 1 diabetes showed complete remission without relapse, and the patient with type 2 diabetes had two relapses; complete remission was sustained after associated treatment with cyclophosphamide and prednisone. Both patients had two years of follow-up evaluation after remission. We discuss the outcomes of both patients and emphasize the role of kidney biopsy in diabetic patients with an atypical proteinuric clinical course, because patients with MCD clearly respond to corticotherapy alone or in conjunction with other immunosuppressive agents.
Division of Nephrology, Department of Internal Medicine, School of Medicine of Ribeirão Preto, Universidade de São Paulo, Brazil. mimoyses@gmail.com
Miguel
M
Moyses Neto
Gyl Eanes Barros
GE
Silva
Roberto S
RS
Costa
Elen A
EA
Romão
Osvaldo Merege
OM
Vieira Neto
Marcio
M
Dantas
D000368:Aged; D001706:Biopsy; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D008854:Microscopy, Electron; D009402:Nephrosis, Lipoid / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D009404:Nephrotic Syndrome / Q000209:etiology* / Q000473:pathology*; D013256:Steroids / Q000627:therapeutic use; D055815:Young Adult
D013256:Steroids