Weinstock R S, Kopecky R T, Jones D B, Sunderji S
Department of Medicine, State University of New York Health Science Center, Syracuse 13210.
Diabetes Care. 1988 May;11(5):416-21. doi: 10.2337/diacare.11.5.416.
In recent years, the prognosis for a successful pregnancy has greatly improved for women with insulin-dependent diabetes mellitus (IDDM) who are under good glycemic control and free of complications such as vascular disease and nephropathy. We report the rapid development of severe nephrotic syndrome, malignant hypertension, and microangiopathic hemolytic anemia during the first trimester of pregnancy in a 29-yr-old woman with IDDM of 18 yr duration. Our patient had no pregestational history of retinopathy or hypertension and only minimal proteinuria. Significant improvement in blood glucose levels had been achieved over the 6 mo before conception. Kidney biopsy performed before the termination of pregnancy at 10 wk gestation revealed diabetic nephropathy. No other etiology for her renal disease could be found. An arteriole was noted to have entrapped red blood cell fragments and platelet thrombi, revealing the probable source of her hemolytic process. By 8 wk postpartum, her nephrotic syndrome and hemolysis had completely resolved. At 3 mo postgestation, the patient's hypertension was still present but less severe. Her serum creatinine has continued to decrease toward normal. This is the first report of a woman with IDDM in White's classification C who developed a toxemia-like syndrome during the first trimester of pregnancy, attributable to the underlying diabetic state.
近年来，对于血糖控制良好且无血管疾病和肾病等并发症的胰岛素依赖型糖尿病（IDDM）女性患者，成功妊娠的预后有了很大改善。我们报告了一名患IDDM达18年的29岁女性，在妊娠早期迅速发展为严重肾病综合征、恶性高血压和微血管病性溶血性贫血。我们的患者孕前无视网膜病变或高血压病史，仅有微量蛋白尿。在受孕前6个月血糖水平已显著改善。妊娠10周终止妊娠前行肾活检显示为糖尿病肾病。未发现其肾病的其他病因。观察到一条小动脉内有红细胞碎片和血小板血栓，揭示了其溶血过程的可能来源。产后8周时，她的肾病综合征和溶血已完全消退。妊娠3个月时，患者仍有高血压，但程度较轻。她的血清肌酐持续下降至正常。这是首例在怀特分类C级的IDDM女性患者，在妊娠早期发生类似毒血症综合征，病因是潜在的糖尿病状态。
