Kidney Week

Abstract: SA-PO277

Vacuolar Tubular Necrosis Caused by Hyperglycemia in a Diabetic Patient

Session Information

• Diabetic Kidney Disease: Clinical - II
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Lee, Sua, Eulji University College of Medicine, Daejeon, Korea (the Republic of)

Sua Lee,

• Jun, Jaehyun, Eulji University College of Medicine, Daejeon, Korea (the Republic of)

Jaehyun Jun,

• Kim, Jeongwoo, Eulji University College of Medicine, Daejeon, Korea (the Republic of)

Jeongwoo Kim,

Introduction

Acute tubular necrosis (ATN) is a disease in which the epithelial cells of the renal tubules are necrotic, accounting for about 45 % of acute renal injury, and the main causes are nephrotoxic drugs and lowering of blood pressure. Vacuolar ATN is a rare form of ATN known to be caused by hyperosmolar substances such as contrast agents, immunoglobulins, and mannitol. We reported a rare case of vacuolar ATN caused by temporary hyperglycemia in a diabetic patient.

Case Description

A 45-year-old man had symptoms of abdominal pain and vomiting for 5 days and a decrease renal function at a primary medical institution. He diagnosed hypertension and type 2 diabetes 5 years ago and was taking medications. He had a feeling of lethargy, general edema and abruptly decreased urine volume 3 weeks ago. On physical examination, blood pressure was 138/80 mmHg, and pretibial pitting edema was observed. In blood chemistry, serum urea/creatinine (Cr) was 78/19.52 mg/dL, and estimated glomerular filtration rate (eGFR) was 2.62 ml/1.73m²/min. serum albumin and spot urine protein-creatinine ratio were 4.5 g/dL and 4.628 g/mg. Glycated hemoglobin A1c and blood glucose level were 8.3 % and 133 mg/dL. Emergent hemodialysis was performed and kidney biopsy was done to identify the cause of acute kidney injury. The vacuolar degeneration and necrosis of renal tubular epithelial cells were observed on light microscopy, and thickening of the glomerular basement membrane was observed on electron microscopy. At 3 months after treatment, renal function was maintained with serum Cr 1.13 mg/dL and eGFR as 70.18 ml/1.73m²/min.

Discussion

Vacuolar ATN may be the cause of acute renal injury in diabetic patient, so it is necessary to differentiate the cause through renal biopsy when there is abrupt renal function decline in diabetic patients.