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Case Reports
. 2019 Jan 16;20(1):22.
doi: 10.1186/s12882-019-1203-7.

Rapid decline of renal function in patients with type 2 diabetes with heavy proteinuria: a report of three cases

Christopher Thiam Seong Lim  1   2   3 , Nurul Zaynah Nordin  4 , N Z Fadhlina  5   4 , M S Anim  5   4 , T Kalaiselvam  5   4 , W Z Haikal  5   4 , Bak Leong Goh  4   6
Affiliations
Case Reports

Rapid decline of renal function in patients with type 2 diabetes with heavy proteinuria: a report of three cases

Christopher Thiam Seong Lim et al. BMC Nephrol. .

Abstract

Background: Although there is a large volume of literature regarding the definition and epidemiology of. Type 2 diabetes nephropathy (T2DN). There has been a paucity of data focused on the rate of transition of T2 DN. Based on our personal observation a certain percentage of our incident end stage renal disease (ESRD) patients from T2DN experienced a rapid decline of renal function. Their rapid decline nature of glomerular filtration rate (GFR) of 46 to 60 mL/min per 1.73m2 per year have far exceeded the KDIGO definitions of acute kidney injury (abrupt decrease in kidney function occurring over 7 days or less), acute kidney disease (acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury initiating event (Chawla et al Nat Rev Nephrol 241-57 2017) or even rapid decliner (eGFR declines > 5 mL/min per 1.73m2 per year) (Chawla et al Nat Rev Nephrol 241-57 2017; Andrassy Kidney Int 622-623 2013).

Case presentation: We describe here three cases of type 2 diabetic patients that have rapid renal deterioration with rate of decline 46 - 60 mL/min per 1.73m2 per year. All the patients are heavily nephrotic. All of the renal biopsies done showed the classical diabetic changes, hypertensive changes, diffuse tubulointerstitial damage, and interstitial nephritis. All of the patients admitted to taking various form of traditional medications in hope of curing their renal disease.

Conclusion: We wish to highlight that type 2 diabetics with massive nephrotic range proteinuria have enhanced risk of rapid renal function deterioration. The patients should be educated about the risks of rapid renal function deterioration when there is presence of heavy proteinuria. High grade proteinuria is likely to inflict the diffuse tubulointerstitial inflammation. The interstitial nephritis could be further worsened by traditional supplements consumption. Timely health education and advice must be undertaken to retard this unwanted rapid renal disease progression.

Keywords: Diabetes mellitus; Proteinuria; Rapid decliners; Risk factors; Tubulointerstitial inflammation traditional medications.

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Conflict of interest statement

Ethics approval

Not applicable.

Consent for publication

Written informed consent was obtained from all three patients for publication of this Case Report and any accompanying images. Copies of the written consent is available for review by the Editor of this journal.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Kimmelstiel-Wilson nodules
Fig. 2
Fig. 2
Tubulo-interstitial inflammation
See this image and copyright information in PMC

References

    1. Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, Bittleman D, Cruz D, Endre Z, Fitzgerald RL, Forni L, Kane-gill SL, Hoste E, Koyner J, Liu KD, Macedo E, Mehta R, Murray P, Nadim M, Ostermann M, Palevsky PM, Pannu N, Rosner M, Wald R, Zarbock A, Ronco C, Kellum JA. acute disease quality initiative workgroup 16. Acute kidney disease and renal recovery: consensus report of the acute disease quality initiative (ADQI) 16 workgroup. Nat Rev Nephrol. 2017;13:241–257. doi: 10.1038/nrneph.2017.2. - DOI - PubMed
    1. Andrassy KM. Comments on ‘KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease’. Kidney Int. 2013;84:622–623. doi: 10.1038/ki.2013.243. - DOI - PubMed
    1. Hovind P, Rossing P, Tarnow L, Smidt UM, Parving HH. Progression of diabetic nephropathy. Kidney Int. 2001;59(2):702–709. doi: 10.1046/j.1523-1755.2001.059002702.x. - DOI - PubMed
    1. Lee P, Johansen K, Hsu CY. End-stage renal disease preceded by rapid declines in kidney function: a case series. BMC Nephrol. 2011;12(1):5. doi: 10.1186/1471-2369-12-5. - DOI - PMC - PubMed
    1. Vigil A, Condés E, Camacho R, Cobo G, Gallar P, Oliet A, Rodriguez I, Ortega O, Mon C, Ortiz M, Herrero JC. Predictors of a rapid decline of renal function in patients with chronic kidney disease referred to a nephrology outpatient clinic: a longitudinal study. Adv Nephrol. 2015;2015.

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