A 35-year-old man with a 12 year history of type 1 diabetes presents with a new onset lower extremity edema and proteinuria. The patient had noted a 25 lb weight gain in a period of 8 weeks and had experienced headaches and blurry vision. He did carry a diagnosis of proliferative diabetic retinopathy in the past and also had had diabetic neuropathy on his feet. His only medication was insulin thought to be administered through an insulin pump. On exam his blood pressure was noted to be 154/100 mmHg. Physical exam was notable for pitting, bilateral lower extremity edema up to his thighs. A renal ultrasound revealed 13 cm measuring kidneys with slightly increased echogenicity. Laboratory testing showed a serum creatinine of 1.2 mg/dl, a serum albumin of 2.6 mg/dl, a total cholesterol of 592 mg/dl, a HbA1C of 18.3 %, and 7 g of protein on a 24 h urine collection. The patient's urine sediment was notable for oval fat bodies and for 5-10 red blood cells per high power field, some of which had dysmorphic features. Does this patient have diabetic kidney disease (DKD)? What argues for DKD? Are there any red flags? Should this patient undergo a renal biopsy? How should this patient be managed? What is his prognosis?
|Original language||English (US)|
|Title of host publication||Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation|
|Publisher||Springer New York|
|Number of pages||14|
|ISBN (Print)||1461444535, 9781461444534|
|State||Published - Nov 1 2013|
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