Significant polar vasculosis in a patient with a 30-year history of type 2 diabetes
| Autor: | Hiroki Mizuno, Kenichi Ohashi, Yoshifumi Ubara, Tatsuya Suwabe, Takeshi Fujii, Naoki Sawa, Masayuki Yamanouchi, Junichi Hoshino, Rikako Hiramatsu, Yasuhiro Oda |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Diabetic neuropathy C-peptide (blood) Endocrinology Diabetes and Metabolism Insulin degludec Type 2 diabetes Neovascularization Leg pain urologic and male genital diseases Kidney lcsh:Diseases of the endocrine glands. Clinical endocrinology Paraesthesia Diabetic nephropathy 0302 clinical medicine Japan Diabetic Nephropathy Medicine Insulin Estimated glomerular filtration rate Insulin glulisine Glomerular basement membrane Diabetes Angiography Diabetic retinopathy Rosuvastatin Metformin Clopidogrel Proteinuria medicine.anatomical_structure Nephrology 030220 oncology & carcinogenesis Hypertension Renal biopsy Adult medicine.medical_specialty Peripheral oedema Nifedipine Urology Renal function Histopathology 030209 endocrinology & metabolism Urinalysis Glucose (blood) Polar vasculosis 03 medical and health sciences Diabetes mellitus Internal Medicine Creatinine (serum) Retinopathy Diabetic foot ulceration Haemoglobin A1c lcsh:RC648-665 Aspirin business.industry urogenital system Asian - Japanese November Type 2 Diabetes Mellitus Diabetes Mellitus Type 2 medicine.disease Unique/Unexpected Symptoms or Presentations of a Disease Diabetic foot Diabetic foot neuropathy Immunoglobulin A Diet Diabetic Foot Syndrome Lansoprazole business |
| Zdroj: | Endocrinology, Diabetes & Metabolism Case Reports Endocrinology, Diabetes & Metabolism Case Reports, Vol 1, Iss 1, Pp 1-6 (2019) |
| ISSN: | 2052-0573 |
| Popis: | Summary We report the renal histology of a 66-year-old man with hypertension, cardiovascular disease, and a 30-year history of type 2 diabetes mellitus with proliferative diabetic retinopathy, diabetic neuropathy, and diabetic foot status post toe amputation. Urinary protein excretion was 1.4 g/gCr, serum creatinine level 0.86 mg/dL, estimated glomerular filtration rate 69 mL/min/1.73 m2, and HbA1c 13–15%, despite using insulin. Light microscopy showed global glomerulosclerosis in 37% of the glomeruli, but the remaining glomeruli were intact. Significant polar vasculosis was present, while arteriolar sclerosis was mild. Electron microscopy revealed a thickened glomerular basement membrane, which is compatible with the early stage of diabetic glomerulopathy. The presented case was unique because glomerular changes seen typically in diabetes were not seen in the patient, despite the long-standing history of diabetes and diabetic comorbidities, while prominent polar vasculosis was found. Polar vascular formation helps preserve the glomeruli by allowing hyperosmotic blood bypass the glomeruli; this decreases intraglomerular pressure and minimizes glomerular endothelial damage. Learning points: A 66-year-old man with a 30-year history of type 2 diabetes mellitus with poor glycemic control underwent renal biopsy, which showed scarce glomerular changes typically seen in diabetic kidney disease and instead revealed significant polar vasculosis. Past studies demonstrated that the increased small vessels around the vascular hilus in diabetic patients originated from the afferent arterioles and drained into the peritubular capillaries. Polar vascular formation may preserve glomerular function by allowing the blood flow to bypass the glomeruli and decreasing the intraglomerular pressure, which minimizes endothelial damage of the glomerular tufts. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|