title: Recurrence of diabetic kidney disease in a type 1 diabetic patient after kidney transplantation.
abstract: Post-transplant hyperglycaemia of diabetic patients may cause recurrent diabetic kidney disease (DKD) in kidney allografts. We report a patient with slowly progressive DKD with calcineurin inhibitor toxicity (CNI) toxicity after the kidney transplantation. A 28-year-old female with type 1 diabetes mellitus underwent successful kidney transplantation from her mother in April 2003, and the kidney graft survived for more than 10 years. She was treated with combined immunosuppressive therapy consisting of cyclosporine and mycophenolate mofetil. After transplantation, she continued to take insulin injection four times per day, but her glycosylated haemoglobin (HbA1c) was above 10%. Protocol allograft kidney biopsies performed 5 and 10 years after transplantation revealed the recurrence of slowly progressive diabetic kidney disease. In addition, arteriolar hyalinosis partly associated with calcineurin inhibitor toxicity (CNI) was detected with progression. Post-transplant hyperglycaemia causes recurrent diabetic kidney disease (DKD) in kidney allografts, but its progression is usually slow. For long-term management, it is important to prevent the progression of the calcineurin inhibitor arteriolopathy, as well as maintain favourable glycaemic control.
authors.affiliation: Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.|Department of Pathology, Kidney Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Nyumura
authors.affiliation: Department of Pathology, Kidney Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Kazuho
authors.initials: K
authors.lastname: Honda
authors.affiliation: Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Babazono
authors.affiliation: Department of Pathology, Kidney Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Horita
authors.affiliation: Department of Surgery, Kidney Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Surgery, Kidney Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Fuchinoue
authors.affiliation: Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Uchigata
mesh_terms: D000328:Adult; D050379:Arteriolosclerosis / Q000139:chemically induced; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D065095:Calcineurin Inhibitors / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D018450:Disease Progression; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage; D007668:Kidney / Q000187:drug effects / Q000378:metabolism / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008854:Microscopy, Electron; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D065095:Calcineurin Inhibitors; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: calcineurin inhibitor toxicity (CIN); diabetic kidney disease (DKD); type 1 diabetes