Abstract
A 45-year-old man was admitted because of nausea and bilateral pretibial edema. Patchy hemorrhage was noted on the optic fundi. Fasting plasma glucose level was 180mg/dl, blood urea nitrogen level 110mg/dl and serum creatinine level 12.1mg/dl. Emergency hemodialysis was performed for uremia. However, urinary excretion of protein was 0.2g/day, and a diagnosis of diabetic nephropathy was doubtful. Prominent bilateral hydronephrosis was revealed by abdominal echography, and residual urine of more than 500ml was found by urethral catheterization. After indwelling catheterization, hydronephrosis was gradually reduced during a period of three weeks, and the blood urea nitrogen and serum creatinine levels were decreased to 40mg/dl and 5.6mg/dl, respectively. Hemodialysis was discontinued. Glomerular lesions on the kidney biopsy specimen were minimal; only thickening of the glomerular basement membrane was present. However, it was evident that the specimen revealed tubular atrophy, interstitial cell infiltration and fibrosis probably due to hydronephrosis.
In this patient, possible reasons why the diabetic nephropathy was slight, in the presence of evident neuropathy and retinopathy, were considered as follows: (1) relatively short duration of diabetes mellitus, (2) the lack of familial history of hypertension and (3) the absence of hypercholesterolemia and atherosclerosis on the kidney biopsy specimen.
