正常アルブミン尿期から血液透析療法に至るまで長期間の経過を観察できた2型糖尿病の1例

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タイトル別名
  • A Type 2 Diabetic Patient with Longstanding Diabetic Nephropathy (DN) Followed from Normoalbuminuria to End-stage Renal Disease: A Case Report
  • ショウレイ ホウコク セイジョウ アルブミン ニョウキ カラ ケツエキ トウセキ リョウホウ ニ イタル マデ チョウキカン ノ ケイカ オ カンサツ デキタ 2ガタ トウニョウビョウ ノ 1レイ

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A 48-year-old woman was admitted in order to undergo hemodialysis (HD) . Her entire clinical course of diabetes was followed at our hospital. The duration from her first visit to the beginning of hemodialysis (HD) was almost 20 years. She was admitted three times for glycemic control, diabetic ketosis and HD induction, respectively. A renal biopsy performed during the first admission revealed typical diabetic glomerulosclerosis. The level of urinary albumin increased from normoalbuminuria to overt proteinuria followed by GFR decline and serum creatinine elevation. Proliferative retinopathy proceeded to overt proteinuria.<br> Glycemic control was achieved with dietary management and insulin therapy, with the exception of self-discontinuance of therapy for six months before the second admission. Microalbuminuria occurred at 33 of years of age followed by overt proteinuria at 36 years of age. Diabetic retinopathy was first diagnosed at 35 years of age and progressed to a proliferative stage within one year.<br> Dietary management and insulin therapy for glycemic control were going well, and the patient's dietary energy was increased during this period. The proteinuria gradually increased and the GFR decreased; however, a preserved stage of chronic renal failure continued for almost 10 years under multifactorial therapy for diabetic nephropathy.<br> This patient followed a typical clinical course of longstanding diabetic nephropathy. Further examinations should be conducted to clarify typical DN cases following a staged classification of DN for type 2 diabetes.<br>

収録刊行物

  • 糖尿病

    糖尿病 56 (1), 24-30, 2013

    一般社団法人 日本糖尿病学会

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