Kim Yoonhong, Kim Dong Il, Shim Jae Ryong, Lee Tae Beom, Yang Kwang Ho, Ryu Je Ho, Lee Hyun Jung, Choi Byung Hyun
Departments of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Departments of Pathology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Korean J Transplant. 2019 Dec 31;33(4):146-152. doi: 10.4285/jkstn.2019.33.4.146.
Pancreas transplantation is the only method that can nearly cure insulin-dependent diabetes mellitus. However, the effect of pancreas transplantation on patients with diabetic nephropathy has recently been considered controversial. In this report, we present a case of abrupt aggravation of proteinuria after successful pancreas transplantation alone without evidence of calcineurin inhibitor (CNI) toxicity. A 22-year-old female patient with type I diabetes mellitus underwent pancreas transplantation alone. The patient already had retinopathy and mild proteinuria, which in this case, may mean diabetic nephropathy. Her glucose levels were managed within the normal range after successful pancreas transplantation. However, the amount of proteinuria fluctuated. Kidney needle biopsy was performed owing to severe elevation of proteinuria, 2 years after the transplantation. Electron microscopy revealed diabetic glomerulosclerosis without evidence of CNI toxicity. This case indicates that diabetic nephropathy can be aggravated after pancreas transplantation, despite well-managed glucose levels and absence of CNI toxicity.
胰腺移植是几乎可以治愈胰岛素依赖型糖尿病的唯一方法。然而，胰腺移植对糖尿病肾病患者的疗效最近一直存在争议。在本报告中，我们呈现了一例在单独成功进行胰腺移植后蛋白尿突然加重的病例，且无钙调神经磷酸酶抑制剂（CNI）毒性的证据。一名22岁的I型糖尿病女性患者接受了单独的胰腺移植。该患者已有视网膜病变和轻度蛋白尿，在这种情况下，可能意味着患有糖尿病肾病。成功进行胰腺移植后，她的血糖水平维持在正常范围内。然而，蛋白尿的量出现波动。移植2年后，由于蛋白尿严重升高，进行了肾穿刺活检。电子显微镜检查显示为糖尿病性肾小球硬化，无CNI毒性的证据。该病例表明，尽管血糖水平得到良好控制且无CNI毒性，但胰腺移植后糖尿病肾病仍可能加重。
