Avilés-Santa Larissa, Alpern Robert, Raskin Philip
Division of Clinical Diabetes, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, G5.238,Dallas, TX 75390-8858, USA.
J Diabetes Complications. 2002 May-Jun;16(3):249-54. doi: 10.1016/s1056-8727(01)00221-5.
Nephrotic syndrome is a condition commonly associated with end-stage renal disease secondary to diabetic nephropathy. It is usually associated with long-standing renal insufficiency, microalbuminuria, and overt proteinuria. We present a diabetic patient with acute oliguric renal failure and nephrotic syndrome. At presentation, he had a serum creatinine of 2.3 mg/dl, blood urea nitrogen (BUN) of 69 mg/dl, urinary protein excretion of 10.5 g/24 h, serum albumin of 1.3 g/dl, and a urine output < 400 cc/24 h. A renal biopsy was done and the renal pathology was compatible with early diabetic nephropathy. Despite intense diuretic therapy, the patient's renal condition did not improve, and peritoneal dialysis was started several months after diagnosis. After 8 months of dialysis therapy, the patient's renal parameters and urinary output spontaneously restored to normal limits (serum creatinine was 1.1 mg/dl, urinary albumin excretion was 411 mg/24 h, serum albumin was 4.3 g/dl, and normal urine output) and dialysis was discontinued. His renal function did not deteriorate after discontinuation of dialysis. We conclude that this patient's reversible acute renal failure and nephrotic syndrome were associated with minimal change disease and not due to diabetic nephropathy.
肾病综合征是一种常与糖尿病肾病继发的终末期肾病相关的病症。它通常与长期肾功能不全、微量白蛋白尿和显性蛋白尿有关。我们报告了一名患有急性少尿性肾衰竭和肾病综合征的糖尿病患者。就诊时，他的血清肌酐为2.3mg/dl，血尿素氮（BUN）为69mg/dl，尿蛋白排泄量为10.5g/24小时，血清白蛋白为1.3g/dl，尿量<400cc/24小时。进行了肾活检，肾脏病理与早期糖尿病肾病相符。尽管进行了强化利尿治疗，患者的肾脏状况并未改善，诊断后数月开始进行腹膜透析。经过8个月的透析治疗，患者的肾脏参数和尿量自发恢复到正常范围（血清肌酐为1.1mg/dl，尿白蛋白排泄量为411mg/24小时，血清白蛋白为4.3g/dl，尿量正常），并停止了透析。停止透析后他的肾功能没有恶化。我们得出结论，该患者可逆的急性肾衰竭和肾病综合征与微小病变疾病有关，而非糖尿病肾病所致。
