Landeros Germán A, Amador Lauro F, Flores Miguel A, Sánchez Ma D, Juárez José O, Abraham Severo M, Jiménez Omar A, Vázquez Jhoana D
Nephrology, Instituto Mexicano del Seguro Social, León, MEX.
Hematology, Instituto Mexicano del Seguro Social, León, MEX.
Cureus. 2025 Mar 3;17(3):e79955. doi: 10.7759/cureus.79955. eCollection 2025 Mar.
Diabetic kidney disease is a very prevalent complication in the context of type 2 diabetes. However, there is evidence showing a high variability in diagnosis when a kidney biopsy is performed. We present a case of a woman with a diagnosis of diabetic kidney disease, systemic arterial hypertension, obesity, and a high risk of progression of chronic kidney disease who presented with a sudden onset nephrotic syndrome and rapidly progressive deterioration of renal function. Kidney biopsy revealed pauci-immune extracapillary glomerulonephritis with acute thrombotic microangiopathy and class IIa diabetic nephropathy. Antineutrophil cytoplasmic antibodies (ANCA) and low complement were detected. The patient received treatment based on plasma exchanges, steroids with methylprednisolone and prednisone and intravenous cyclophosphamide with improvement of renal function. In conclusion, expansion of kidney biopsy criteria in patients with a diagnosis of type 2 diabetes is mandatory to provide adequate treatment and prognosis in the context of a high prevalence of alternative or concomitant disease.
糖尿病肾病是2型糖尿病背景下非常常见的并发症。然而，有证据表明，进行肾活检时诊断存在高度变异性。我们报告一例诊断为糖尿病肾病、系统性动脉高血压、肥胖且慢性肾病进展风险高的女性病例，该患者突发肾病综合征且肾功能迅速进行性恶化。肾活检显示寡免疫性毛细血管外肾小球肾炎伴急性血栓性微血管病及IIa级糖尿病肾病。检测到抗中性粒细胞胞浆抗体（ANCA）及低补体。患者接受了基于血浆置换、甲泼尼龙和泼尼松的类固醇治疗以及静脉注射环磷酰胺治疗，肾功能有所改善。总之，对于诊断为2型糖尿病的患者，扩大肾活检标准对于在存在替代或伴随疾病高患病率的情况下提供充分治疗和预后至关重要。
