Development of Diabetes Mellitus Several Years after Manifestation of Diabetic Nephropathy: Case Report and Review of Literature

doi:10.4158/EP.9.4.301

Endocrine Practice

Volume 9, Issue 4, July–August 2003, Pages 301-306

https://doi.org/10.4158/EP.9.4.301 Get rights and content

ABSTRACT

Objective

To describe an unusual case of development of diabetes mellitus (DM) several years after manifestation of diabetic nephropathy and to review the related literature.

Methods

We present a case report, including detailed laboratory and pathologic findings in a 51-year-old man who was diagnosed as having DM several years after presenting with diabetic nephropathy. The pertinent literature is also reviewed.

Results

A 51-year-old African American man presented with proteinuria of 4 g/24 h. Past medical history was significant for impaired glucose tolerance diagnosed 2 years previously. Subsequent follow-up demonstrated fasting blood glucose levels ranging from 108 to 123 mg/dL and glycated hemoglobin levels ranging from 5.3 to 5.8%. The patient also had chronic hepatitis C, hypertension, a history of intravenous drug abuse, and a family history of DM and hypertension. On examination of the patient, his blood pressure was 180/90 mm Hg. Funduscopy revealed mild diabetic retinopathy. Work-up was negative for glomerulonephritis, connective tissue disease, vasculitis, or multiple myeloma. Kidney biopsy revealed thickened glomerular basement membranes and diffuse glomerulosclerosis, consistent with diabetic nephropathy. During follow-up, 9 years after presenting with proteinuria and 4 years after diagnosis of biopsy-proven diabetic nephropathy, the patient had a blood glucose level of 890 mg/dL and diabetic ketoacidosis.

Conclusion

This case provides one explanation for the natural course of patients who present with “diabetic complications” but have no diabetes. Some of those patients may have “prediabetes” and may manifest with DM during follow-up. We also conclude that hyperglycemia is not the only important factor in the pathogenesis of diabetic nephropathy. (Endocr Pract. 2003;9:301- 306)

Section snippets

INTRODUCTION

Diabetic nephropathy is a manifestation of the microangiopathy thought to result from the hyperglycemia of diabetes mellitus (DM) 1., 2., 3., 4.. The prevalence and severity of diabetic nephropathy generally correlate with the duration of DM 5., 6., but other entities including genetic, racial, and ethnic factors are also believed to have a role 7., 8..

When renal disease manifests in a patient with DM, distinguishing whether it is due to diabetic nephropathy or due to nondiabetic disease is

CASE REPORT

A 51-year-old African American man was found to have nephrotic-range proteinuria (4 g/24 h) in October 1998. His past medical history was significant for chronic hepatitis C (liver biopsy in 1997; interferon therapy in the past), hypertension, and asthma. He also had a history of intravenous drug abuse and exposure to hepatitis B (positive antibodies, negative hepatitis B surface antigen). In 1996, a gastric emptying study performed as part of a work-up for vague abdominal symptoms revealed

DISCUSSION

The epidemiology of diabetic nephropathy has most frequently been studied in type 1 DM because the clinical onset is usually known (24). The frequency of clinical nephropathy in patients with type 1 DM has been reported to be 40 to 50% (6). Recognized risk factors for development of diabetic nephropathy include duration of diabetes (5), degree of glycemic control 2., 3., 4., and other features such as genetics, race, and ethnicity 7., 8..

Pathogenetic factors implicated in diabetic nephropathy

CONCLUSION

Our current case of diabetic nephropathy preceding DM provides one explanation for the natural course of patients who present with “diabetic complications” but have no diabetes. We also conclude that hyperglycemia is not the only important factor in the pathogenesis of diabetic nephropathy. Further studies of the interaction between hyperglycemia and other risk factors in the development of nephropathy should be undertaken.

ACKNOWLEDGMENT

An abstract of this case was presented at the 9th annual meeting of the American Association of Clinical Endocrinologists in Atlanta, Georgia, in May 2000.

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Case ReportDevelopment of Diabetes Mellitus Several Years after Manifestation of Diabetic Nephropathy: Case Report and Review of Literature

ABSTRACT

Objective

Methods

Results

Conclusion

Section snippets

INTRODUCTION

CASE REPORT

DISCUSSION

CONCLUSION

ACKNOWLEDGMENT

Prim Care.

Am J Med.

Am J Med.

Am J Med.

Metabolism.

Kidney Int.

Lancet.

Am J Kidney Dis.

Kidney Int.

Diabetic nephropathy and proliferative retinopathy with normal glucose tolerance

Diabetes Care.

Nonenzymatic gly- cosylation and the pathogenesis of diabetic complications

Ann Intern Med.

Relation of diabetic control to development of microvascular complications

Diabetologia.

The Banting Memorial Lecture 1978: clinical and etiologic heterogeneity of idiopathic diabetes mellitus

Diabetes.

Diabetic nephropathy in type 1 (insulin dependent) diabetes: an epidemiological study

Diabetologia.

Genetic susceptibility to the development of retinopathy in insulin-dependent diabetics

Diabetes.

Genetic and immunological factors in microvascular disease in type I insulin-dependent diabetes

Diabetes.

Idiopathic membranous glomerulonephritis in diabetic patients: report of three cases and review of the literature

Arch Intern Med.

Idiopathic membranous glomerulonephritis associated with diabetes mellitus: light, immunofluorescence and electron microscopic study

Nephron.

Concomitant presence of three different glomerular diseases in the same patient: report of a case and review of the literature

Nephron.

Case Report
Development of Diabetes Mellitus Several Years after Manifestation of Diabetic Nephropathy: Case Report and Review of Literature