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Diabetic kidney disease is a frequent complication of diabetes. However, the prevalence of an alternate diagnosis to diabetic nephropathy is high in patients with diabetes with a reported prevalence of up to 82%. Of these, IgA nephropathy is the most common diagnosis. Only one study evidenced the presence of renal vasculitis with a prevalence of only 15%. We present a case of ANCA-mediated vasculitis in a patient with type 2 diabetes of more than 15 years of evolution.
A 70-year-old woman with a diagnosis of type 2 diabetes and systemic arterial hypertension for more than 15 years. She consulted the nephrology department and reported 3 months of increased volume in the lower extremities with progressive evolution until anasarca. Physical examination revealed a BMI of 48.8 kg/m2 and a cervical circumference of 55 cm. Initial labs showed a serum creatinine of 2.9 mg/dl. Blood urea nitrogen 76 mg/dl. Urinalysis: urine density 1.015, pH 5.0, protein 100 mg/dl. Leukocytes 10 - 15/field, erythrocytes 25 - 30/field. Quantification of 24-hours urine proteins: 5700 mg. C3: 60 mg/dl. C4: 9.0 mg/dl. P-ANCA: 190.8 UR/ml. A renal ultrasound was performed with measurements of 12.3 cm; 5.4 cm; 5.6 cm. No structural damage. Diagnosis of diabetic retinopathy was made.
Conclusions
The relevance of performing a renal biopsy in a patient with type 2 diabetes is to be able to provide specific treatment and identify those at risk of recurrence in case of renal transplantation. In a retrospective study where 611 renal biopsies in patients with type 2 diabetes were taken into account, only 37% showed isolated diabetic nephropathy, 36% non-diabetic renal disease being focal and segmental glomerulosclerosis the most frequent diagnosis and pauci-immune glomerulonephritis the most infrequent diagnosis. These findings suggest the relevance of performing renal biopsy in patients with type 2 diabetes. The present case is interesting because the presentation of pauci-immune glomerulonephritis is the most frequent in patients with serologic evidence of ANCA antibodies and diabetes. To date we have only identified 10 patients with ANCA-associated glomerulonephritis and type 2 diabetes in the literature.
Note: This abstract was also submitted for the 70th International Congress on Nephrology IMIN 2023 congress. By submitting the abstract to WCN’24, abstract authors declare that re-submitting the abstract is permitted by the organizers of the previous meeting.