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2015 ; 4
(1
): 101-105
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
A case of "hidden" diabetic nephropathy diagnosed by a combination of renal
biopsy findings and continuous glucose monitoring system
#MMPMID28509279
Nishihama K
; Nakai T
; Kanai K
; Sugiyama T
; Kosato H
; Oka N
; Yasutomi M
; Murata K
; Ohnishi T
; Yabana T
CEN Case Rep
2015[May]; 4
(1
): 101-105
PMID28509279
show ga
Although diabetic nephropathy is a microvascular complication of diabetes
mellitus, some reports suggest that renal biopsy often shows this pathological
change without a diagnosis of diabetes mellitus. Here, we report a case of a
65-year-old man who presented with proteinuria, hypoalbuminemia and hypertension
without a diagnosis of diabetes mellitus. He drank alcohol regularly and was a
heavy smoker. Renal biopsy revealed a diffuse increase in the mesangial area,
mesangial nodules or well-developed hyalinosis, interstitial fibrosis, and
arteriosclerosis consistent with the changes of diabetic nephropathy. Although we
had initially diagnosed him with idiopathic nodular glomerulosclerosis, use of a
continuous glucose monitoring system (CGMS) revealed that the changes in his
daily blood glucose concentrations met with the diagnostic criteria of diabetes
mellitus. Accordingly, we diagnosed him with diabetic nephropathy and initiated
treatment for diabetes mellitus. This case suggests that some cases of diabetic
nephropathy may be hidden among patients with impaired glucose tolerance, who are
not diagnosed with diabetes mellitus. Use of a CGMS may be helpful in diagnosing
this type of "hidden" diabetes mellitus. In addition to diet therapy, smoking
control, treatment for hypertension, and strict control of hyperglycemia may be
important for these patients.