Case Study: Renal Disease in Type 1 Diabetes

C.M. is a 27-year-old woman with type 1 diabetes diagnosed at age 14 when she presented with diabetic ketoacidosis. Her initial insulin treatment was complicated by poor glycemic control, frequent hypoglycemia, and weight gain.Two years ago, she developed hypertension, which was treated with hydrochlorthiazide, 25 mg daily. At that time, she was noted to have nonproliferative diabetic retinopathy. Blood urea nitrogen (BUN) was 23 mg/dl, creatinine was 0.9 mg/dl, and dipstick urinalysis was negative for protein.She now presents with accelerated hypertension (172/108 mmHg) and pitting edema of the legs to the level of the knees. Urinalysis reveals 3+ protein and 2+ blood. Urine microscopic analysis reveals hyalin and red blood cell casts. BUN is 37 mg/dl; creatinine is 1.5 mg/dl; and 24-h urine reveals 9.7 g of protein. …