Membranoproliferative Glomerulonephritis Associated with Insulin-Dependent Diabetes mellitus

Bilgin Yüksel, Güzelyah Mah. Uğur Mumcu Cad., Duygu Sitesi B, Blok No. 9, Adana (Turkey) Dear Sir, The prevalence of nondiabetic renal disease in diabetic patients is not known. From a review of the relevant literature, most of which consists of isolated case reports, a wide spectrum of nondiabetic renal lesions can occur in patients with diabetes [1-4]. Although proteinuria is frequently the initial urinary abnormality observed in diabetic ne-phropathy, the nephrotic syndrome is rarely seen in diabetic children [1, 5, 6]. Here, we report the case of an adolescent with insulin-dependent diabetes mellitus (IDDM) who developed membranoproliferative glomerulonephritis (MPGN) 3 years after the diagnosis of diabetes. To the best of our knowledge, IDDM and MPGN have never been reported in children. A 14-year-old girl with a 3-year history of IDDM was admitted to hospital because of edema. On admission, blood pressure was 120/80 mm Hg, pulse rate 82/min and pre-tibial edema was 3+. Fundoscopic examination revealed no microaneurysm or exudate. Laboratory studies showed a normal blood cell count with ESR 60 mm/h. Urinalysis revealed specific gravity 1,025, protein > 300 mg/dl, glucose 100 mg/dl and 24-hour protein excretion was 145 mg/m2/h. BUN, serum creatinine, total serum protein and serum albumin were 18 mg/dl, 0.6 mg/dl, 5.6 g/dl and 2.2 g/dl respectively. The blood glucose level was fairly well controlled by dieting and insulin therapy (blood glucose 256 mg/dl, HbA^ 12.7). C3 and C4 were within normal limits, ANA, CRP, and rheumatoid factor were negative. HbsAg, anti-Hbs, anti-Hbe, anti-delta and anti-HCV were also negative; HAV-IgM was positive. A percutaneous renal biopsy was performed and demonstrated glomerular enlargement and lobulation, mesangial matrix increment and basal membrane thickening. Diffuse deposition of IgG and IgM on the glomerular mesangium were revealed immunohisto-chemically. Prednisolone 60 mg/m2/day, cy-clophosphamide 2 mg/kg/day and dipyrida-mole 8 mg/kg/day were begun and she continued to receive 45 U/day insulin. The patient described in this report had IDDM, and a nephrotic syndrome manifested by generalized edema. Diabetic ne-phropathy is a well-recognized complication of diabetes mellitus but in our case the duration of diabetes mellitus was short and did not demonstrate