Department of Medicine, Division of Nephrology, David Geffen UCLA School of Medicine, 7-155 Factor Building; Mail Code 168917, Los Angeles, CA, 90095, USA.
Department of Pathology and Laboratory Medicine, David Geffen UCLA School of Medicine, Los Angeles, USA.
BMC Nephrol. 2021 Dec 11;22(1):412. doi: 10.1186/s12882-021-02620-7.
Simultaneous pancreas-kidney transplantation is considered a curative treatment for type 1 diabetes complicated by end-stage kidney disease. We report herein a case of mesangial sclerosis in a patient who underwent successful kidney-pancreas transplantation despite well-controlled glucose and excellent pancreatic allograft function.
A 76-year-old type 1 diabetic man who underwent a simultaneous pancreas-kidney transplantation 19 years prior presented with persistent nephrotic range proteinuria although creatinine was at his baseline (normal) level. Hemoglobin A1c and fasting glucose were well controlled without the use of insulin or oral antihyperglycemic agents. Serum lipase and amylase were within the reference range and there was no evidence of donor-specific antibodies. Kidney allograft biopsy was performed to evaluate proteinuria and showed diffuse capillary loop thickening and diffuse moderate to severe mesangial sclerosis resembling diabetic nephropathy.
This case demonstrates a case of mesangial sclerosis resembling diabetic nephropathy in a patient with good glucose control after simultaneous pancreas-kidney transplantation with excellent pancreatic allograft function.
胰肾联合移植被认为是治疗伴有终末期肾病的 1 型糖尿病的一种根治方法。尽管血糖得到良好控制且胰腺移植物功能良好，但我们报告了一例在成功进行胰肾联合移植后发生系膜硬化的患者。
一名 76 岁的 1 型糖尿病男性，19 年前接受了胰肾联合移植，尽管血肌酐处于基线（正常）水平，但仍持续出现肾病范围蛋白尿。糖化血红蛋白和空腹血糖控制良好，未使用胰岛素或口服降糖药。血清脂肪酶和淀粉酶在参考范围内，也没有供体特异性抗体的证据。为了评估蛋白尿，对肾脏移植物进行了活检，结果显示弥漫性毛细血管袢增厚和弥漫性中重度系膜硬化，类似于糖尿病肾病。
本例在胰肾联合移植后血糖控制良好且胰腺移植物功能良好的情况下，表现为类似于糖尿病肾病的系膜硬化。
