Podocytopathy in Diabetic Nephropathy
- Glomerular Diseases: Podocyte Biology - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1403 Podocyte Biology
- Ravi, Divya, Rochester Regional Health, Rochester, New York, United States
- AL Wahadneh, Mohammad, Rochester Regional Health, Rochester, New York, United States
- Choudhry, Wajid M., Rochester Regional Health, Rochester, New York, United States
Minimal change disease constitutes 15% of adult idiopathic nephrotic syndrome. The exact mechanism is unknown but is postulated to be due to T cell dysfunction and the production of glomerular permeability factor. With an underlying immune mechanism involved, minimal change disease responds to steroids and steroid-sparing agents. We present a case of diabetic kidney disease with overlying podocytopathy.
A 47-year-old female with a past medical history of hypertension, and poorly controlled diabetes presented with complaints of worsening swelling of legs along with abdominal distension and reported weight gain of 40 pounds over a few weeks. She reported no improvement with oral furosemide 40 mg daily which she was prescribed for her edema and was not using her insulin for the past 9 months before admission. Her creatinine at presentation was 0.9. 24-hour urine protein revealed 6.4 grams/day. Autoimmune workup was negative. The patient was started on IV diuretics. She underwent a kidney biopsy which revealed moderate chronic kidney disease with podocyte foot effacement suggestive of minimal change disease. CT imaging was done to assess for any lymphoproliferative disease which found mildly enlarged inguinal lymph nodes. Oncology was consulted for the possibility of lymphoproliferative disease and believed that malignancy was unlikely. The patient was offered a steroid course versus immunosuppressive medications like mycophenolate mofetil. The patient chose to start mycophenolate mofetil to avoid steroids and their effect on diabetes. Proteinuria decreased and patient was discharged on mycophenolate mofetil 1000 mg twice daily with outpatient follow-up.
Minimal change disease is often an idiopathic disease but has also been known to be associated with the use of certain drugs, infections, and hematological malignancies. The mainstay of diagnosis remains to be a kidney biopsy. In our patient, the most likely diagnosis at presentation was diabetic kidney disease from poorly controlled diabetes, the kidney biopsy proved vital in the assessment of the coexisting minimal change disease. Few case reports have been listed where patients with diabetes presented with sudden onset nephrotic syndrome and were found to have minimal change disease.