Minimal change disease associated with type 1 and type 2 diabetes mellitus

Abstract

A 19-year-old female with type 1 diabetes for four years, and a 73-year-old female with type 2 diabetes for twenty years developed sudden-onset nephrotic syndrome. Examination by light microscopy, immunofluorescence, and electron microscopy (in one case) identified minimal change disease (MCD) in both cases. There was a potential causative drug (meloxicam) for the 73-year-old patient. Both patients were treated with prednisone and responded with complete remission. The patient with type 1 diabetes showed complete remission without relapse, and the patient with type 2 diabetes had two relapses; complete remission was sustained after associated treatment with cyclophosphamide and prednisone. Both patients had two years of follow-up evaluation after remission. We discuss the outcomes of both patients and emphasize the role of kidney biopsy in diabetic patients with an atypical proteinuric clinical course, because patients with MCD clearly respond to corticotherapy alone or in conjunction with other immunosuppressive agents.

Nephrotic syndrome co-existing with type 1 diabetes in a 12-year-old boy: Case report and literature review

“…The incidence of nephrotic syndrome in children in the United States and Europe is 1–7 per 100,000 children. 7–9 Patients with T1DM present with proteinuria (diabetic nephropathy) at a late stage, 10 approximately 12 years after the onset of diabetes. 11 A short period of T1DM and the absence of target organ damage (e.g.…”

“…Physical examination revealed pitting edema on the legs and face; urinalysis showed proteinuria of 5.3 g/24 h, and renal biopsy findings indicated MCD. 10…”

Type 1 Diabetes and Other Autoimmune Disorders in Children

“…However, several cases of idiopathic nephrotic syndrome in the set of T1D have been reported [130], and the mutual immune roots support a noncoincidental association. Despite the exact mechanism being unknown, many case reports suggest a mutual genetic component given an overlap for HLA in many patients, such as DR4, DR7, and DR53 [130][131][132][133][134].…”