Sonar Nirmay, Pennington Jarvis, Borda Mishell Siles, Sadiq Zaynah, Beasey Matthew, Poobalasingham Sathiyendram
Internal Medicine, Norton Community Hospital, Norton, USA.
Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, USA.
Eur J Case Rep Intern Med. 2025 Jul 3;12(8):005378. doi: 10.12890/2025_005378. eCollection 2025.
Diabetic kidney disease is traditionally regarded as a complication of chronic hyperglycaemia associated with diabetes. However, the relationship between glycaemic thresholds and the development of diabetic kidney disease is increasingly questioned. We present a case of a 69-year-old woman with progressive renal dysfunction and biopsy findings suggestive of diabetic kidney disease, despite repeatedly normal glycosylated haemoglobin (haemoglobin A1c) and without a clinical diagnosis of diabetes or pre-diabetes. This case highlights the limitations of current haemoglobin A1c thresholds and raises the question of whether diabetic kidney disease can truly develop in the absence of diabetes. Stricter glycaemic criteria may help identify at-risk patients earlier and prevent renal complications.
Diabetic kidney disease can occur without overt diabetes or pre-diabetes, challenging current diagnostic methods.Reliance on haemoglobin A1c alone may miss at-risk individuals, and stricter glycaemic thresholds may be warranted.The diagnosis of diabetic kidney disease in normoglycemic patients challenges disease definitions and pathogenesis.
糖尿病肾病传统上被视为与糖尿病相关的慢性高血糖并发症。然而，血糖阈值与糖尿病肾病发生之间的关系越来越受到质疑。我们报告一例69岁女性，尽管糖化血红蛋白（血红蛋白A1c）反复正常，且无糖尿病或糖尿病前期的临床诊断，但出现进行性肾功能不全，活检结果提示糖尿病肾病。该病例凸显了当前血红蛋白A1c阈值的局限性，并引发了糖尿病肾病在无糖尿病情况下是否真的会发生的问题。更严格的血糖标准可能有助于更早识别高危患者并预防肾脏并发症。
糖尿病肾病可在无明显糖尿病或糖尿病前期的情况下发生，对当前诊断方法构成挑战。仅依赖血红蛋白A1c可能会遗漏高危个体，可能需要更严格的血糖阈值。血糖正常患者的糖尿病肾病诊断对疾病定义和发病机制提出了挑战。
