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