Miao Pengwei, Mo Xiuting, Zhang Xingkun, Zhang Mianzhi
Tianjin University of Traditional Chinese Medicine, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China.
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjiin, China.
Front Endocrinol (Lausanne). 2025 Jul 18;16:1623272. doi: 10.3389/fendo.2025.1623272. eCollection 2025.
Type 2 diabetes mellitus (T2DM) has become the main cause of end stage renal disease (ESRD) in the past decade. Diabetic kidney disease (DKD) is one of the most serious complications of diabetes. In clinical practice, the diagnosis of DKD is based primarily on clinical criteria, that is, patients almost do not undergo renal biopsy, leading to many non-diabetic kidney diseases (NDKDs) being misdiagnosed as DKD, thus increasing the incidence rate of DKD. The incidence of NDKD is also higher in those with DM. To date, few cases of minimal change disease (MCD) among those with DKD have been reported. Here, we report a case of diabetic nephropathy with pathological diagnosis, which was considered to be complicated with MCD according to the medical history, and was completely relieved after glucocorticoid treatment.
A 49-year-old male patient with a diabetes duration of 3 years was admitted to our hospital mainly because of "bilateral lower extremity edema for 1 month". The clinical manifestations were nephrotic syndrome and diabetic nephropathy, which were confirmed by renal biopsy. According to the medical history, DKD with MCD was considered. The patient received glucocorticoid for 6 months and was completely relieved of proteinuria.
Renal biopsy is helpful to differentiate diabetes with chronic kidney disease (CKD). DKD and DKD with MCD can be differentiated in the early stage of DKD but are difficult to differentiate in the late stage of DKD. In clinical practice, for such patients, we should also diagnose them carefully based on their medical history to reduce the misdiagnosis rate.
在过去十年中，2型糖尿病（T2DM）已成为终末期肾病（ESRD）的主要病因。糖尿病肾病（DKD）是糖尿病最严重的并发症之一。在临床实践中，DKD的诊断主要基于临床标准，即患者几乎不进行肾活检，导致许多非糖尿病肾病（NDKD）被误诊为DKD，从而增加了DKD的发病率。NDKD在糖尿病患者中的发病率也较高。迄今为止，DKD患者中微小病变病（MCD）的病例报道较少。在此，我们报告一例经病理诊断的糖尿病肾病病例，根据病史考虑合并MCD，经糖皮质激素治疗后完全缓解。
一名49岁男性患者，糖尿病病程3年，因“双下肢水肿1个月”入院。临床表现为肾病综合征和糖尿病肾病，经肾活检确诊。根据病史，考虑为合并MCD的DKD。患者接受糖皮质激素治疗6个月，蛋白尿完全缓解。
肾活检有助于鉴别糖尿病与慢性肾脏病（CKD）。DKD和合并MCD的DKD在DKD早期可鉴别，但在DKD晚期难以鉴别。在临床实践中，对于此类患者，我们也应根据病史仔细诊断，以降低误诊率。
