Preservation of renal function by intensive glycemic control. (8th January 2018)

• Record Type: Journal Article
• Authors: Toriu, Naoya; Yamanouchi, Masayuki; Hiramatsu, Rikako; Hayami, Noriko; Hoshino, Junichi; Sekine, Akinari; Kawada, Masahiro; Hasegawa, Eiko; Suwabe, Tatsuya; Sumida, Keiichi; Ueno, Toshiharu; Sawa, Naoki; Ohashi, Kenichi; Fujii, Takeshi; Takaichi, Kenmei; Yanagita, Motoko; Kobayasi, Tetsuro; Ubara, Yoshifumi
• Is Part Of: Endocrinology, diabetes & metabolism case reports. (2018)
• Publication Date: 2018-01-08
• Subjects: Adult -- Female -- Asian ‐ Japanese -- Japan; Kidney -- Diabetes -- Insulin -- Diabetes mellitus type 1 -- Diabetic nephropathy -- Hyperglycaemia; Diabetes mellitus type 1 -- Nephropathy -- Renal failure -- Hyperglycaemia -- Albuminuria -- Proteinuria -- Arteriosclerosis -- Haemoglobin A1c -- Renal biopsy -- Glucose (blood) -- Estimated glomerular filtration rate -- Albumin -- Creatinine (serum) -- White blood cell count -- Red blood cell count -- Haemoglobin -- Urea and electrolytes -- C-reactive protein -- Total cholesterol -- Immunoglobulins -- Immunohistochemistry -- Kidney function -- Blood pressure -- Insulin -- Angiotensin receptor antagonists; Nephrology; Insight into disease pathogenesis or mechanism of therapy -- January -- 2018; Endocrinology -- Periodicals; Diabetes -- Periodicals; Diabetes Mellitus; Endocrinology; Diabetes; Endocrinology; Case Reports; Periodicals; Periodicals; 616.4
• DOI: 10.1530/EDM-17-0136
• Languages: English
• ISSNs: 2052-0573

Abstract

Summary: We report the case of a 67-year-old Japanese woman with type 1 diabetes mellitus. At 47 years of age, her hemoglobin A1c (HbA1c) was 10.0%, and she had overt nephropathy. The first renal biopsy yielded a diagnosis of diabetic nephropathy. Intensive glycemic control was initiated and her HbA1c improved to 6.0%. Renal dysfunction showed no progression for 15 years. At 62 years of age, a second renal biopsy was performed. Glomerular lesions did not show progression but tubulointerstitial fibrosis and vascular lesions showed progression compared with the first biopsy. Intensive glycemic control can prevent the progression of glomerular lesions, but might not be effective for interstitial and vascular lesions. Learning points: Intensive control of blood glucose can prevent the progression of glomerular lesions. Intensive control of blood glucose may not be able to prevent progression of interstitial and vascular lesions. CSII reduces HbA1c without increasing the risk of hypoglycemia.