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Type 3c diabetes or Chronic calcific pancreatitis (CCP)- related diabetes mellitus, arises from irreversible pancreatic damage, sub-acute to acutely, involving both endocrine and exocrine components overtime. The resulting metabolic instability, malnutrition, and chronic inflammation predispose to multisystem complications, including renal injury. However, renal manifestations in this context are seldom recognized. Here we describe 3 uncommon cases of renal involvement, emphasizing early preventive and multidisciplinary strategies.
We had 3 patients with type 3c DM with different presentations at the onset of the disease, with different spectrum of renal manifestations and severity- including AONS, hyper- catabolic AKI and stable CKD. All the patients were managed with insulin therapy with couple of hypo and hyperglycaemic events, broad-spectrum antibiotics, diuretics, pancreatic enzyme supplementation tailored to each patient and comprehensive supportive care to everyone. Follow-up included assessment of complications and survival outcomes.
All 3 patients demonstrated marked improvements in the clinical profile with proper counselling (including psychiatric care), strategic treatment, nutritional supplementation and regular follow-up.
Data at the time of presentation
Patient
X
Y
Z
Age (yrs.)
26
30
36
Sex
F
M
BMI (Kg/ m2)
17. 68
19.32
20.36
Co- morbidities
Hypothyroidism
Nil
HTN
DM duration (yrs.)
4
Not aware
5
Presentation
Sepsis, Shock and Anasarca
Anuria
Asymptomatic renal dysfunction
Diagnosis
AONS
AKI- AKIN III
CKD
Etiology
DKD
CAP
Prerenal+ Intrinsic
Recurrent severe pancreatitis
CCP etiology
Idiopathic
Alcoholic
Funds
DR +
No DR
DR+
Hb (mg/ dl)
6.42
9.60
10.76
TLC
26540
17680
7538
S. Procalcitonin (ng/ ml)
24.62
0.9
-
S. Albumin (g/ dl)
2.83
3.0
3.3
Creatinine (mg/ dl)
0.34
13.78
2.43
TSH (mlU/ L)
12.08
3.66
4.21
ANA
Negative
CUE- P
3+
2+
UPCR
5.4
0.6
0.92
24 H. Urine Protein
6.0 gms
0.62 gms
TG/ T.Ch (mg/ dl)
180/ 320
50/ 140
119/ 155
S. Amylase/ Lipase (U/ L)
22/ 24.30
443/ 188
28/ 27
HbA1c
14.6
11.7
7.9
USG abdomen- Pancreas structure
Atrophic pancreatic parenchyma, dilated MPD, calcifications in variation in pancreatic head noted in all the patients
Urine Output
Maintained
Oliguria/ anuria
HD Sessions
13 Sessions of SLED/ Weaned off HD
Table: 1.
Current Status
9.7
14.7
11.28
3.6
3.8
4.0
0.62
1.3
2.87
2.6
0.2
0.37
18/ 21
32/ 22
26/ 38
9.2
6.8
7.3
Post Discharge
12 months
8 months
5 months
Hospitalizations
(Pain abdomen and Steatorrhea) x 2
(Pain abdomen and Steatorrhea) x 1
Pancreatic enzyme supplementation
Yes
Table: 2.
Brittle diabetes can manifest with diverse renal pathologies, from reversible AKI to progressive CKD and nephrotic syndrome. Malnutrition, sepsis, and glycemic variability are key modifiable risk factors accelerating renal decline. Early and diligent recognition, timely referral, metabolic correction, and coordinated pancreatic–renal management are crucial for prevention of irreversible kidney injury in this under recognized disorder.
