title: Posttransplantation normoglycemic diabetic nephropathy: the role of the allograft insulin resistance--a case report.
abstract: BACKGROUND
  The pathogenesis of diabetic nephropathy is incompletely understood. Although the role of hyperglycemia is well-established, the participation of insulin resistance is increasingly appreciated. Podocytes are insulin responsive cells and require normal insulin signaling for sustained viability.
  
  
  METHODS
  We have presented a renal transplant recipient with lupus nephritis who received a deceased donor kidney from a patient with diabetes mellitus (DM). The kidney functioned well initially. Within 2 years, however, nephrotic range proteinuria developed, and a biopsy revealed diabetic nephropathy that had clearly evolved in comparison with the implantation biopsy. The recipient was repeatedly normoglycemic with normal glycated hemoglobin and glucose tolerance, and she was found to be quite insulin sensitive on the basis of a low homeostasis model assessment of insulin resistance.
  
  
  CONCLUSIONS
  We argue that the nephropathy developed in the allograft owing to impaired insulin signaling from intrinsic donor-derived insulin resistance that was exacerbated by low insulin levels in the insulin-sensitive recipient. This case has implications for the most appropriate utilization of kidneys from donors with DM.
authors.affiliation: Division of Nephrology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. Electronic address: kidneys@comcast.net.
authors.forename: E J
authors.initials: EJ
authors.lastname: Filippone
authors.affiliation: Division of Nephrology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: F
authors.initials: F
authors.lastname: Abubacker
authors.affiliation: Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: J L
authors.initials: JL
authors.lastname: Farber
mesh_terms: D000328:Adult; D064591:Allografts; D003928:Diabetic Nephropathies / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells; D016030:Kidney Transplantation; D008181:Lupus Nephritis / Q000601:surgery; D050199:Podocytes / Q000502:physiology; D066027:Transplant Recipients