Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus Patient- a Case Report

Background We report a type 2 diabetes mellitus (T2DM) patient with clinical and laboratory features of nephrotic syndrome. Pathohystological findings (PH) of the biopsy performed idiopathic membranous nephropathy (MN). Case presentation: The 54 years old male patient was admitted to the hospital with clinical and laboratory features of nephrotic syndrome (initial value of serume creatinine was 1.87 mg/dl, creatinine clearance was 57 ml/ min, daily proteinuria was 16 g). Immunological analyses (ANA-Hep2(IgG), ANCA, anti GBM At(IgG), antiPLA2R(IgG) antibodies) and tumour markers were negative. Abdominal ultrasound examination showed both kidneys to be normal diameter with parenchyma thickness of 17–18 mm, emphasized pyramids on both sides, without stasis or calculosis. Then macrohematuria appeared (value sCr 4.38 mg/dl) and CT urography was done- thrombosis of the left renal vein along it’s entire length, venous stasis and edema of the left kidney, ureterohydronephrosis stage I/ II left; signs of ureteritis on the left side and subsequent tumour of the proximal part of the ureter - focally thickened wall of the ureter in that part. The urethritis was treated with quinolones. After 7 days CT scan was repeated and confirmed the high suspicion of a tumour of the ureteropelvic junction and the proximal part of the ureter; stage II ureterohydronephrosis remained on the left side. An exploratory retrograde ureterorenoscopy was performed. The procedure revealed no evidence of tumour, and JJ stent has been placed in the left ureter. Daily proteinuria was still nephrotic range (13.45 g). After one month, the JJ stent was removed. Two months later, a control CT scan of the abdomen and pelvis was conducted, and a kidney biopsy was performed. The PH findings showed MN. The patient received the first dose of Rituximab at 375 mg/m ² (750 mg intravenously). This same dose was administered again after two weeks. Conclusions Patients with T2DM, nephrotic syndrome and rapidly declining renal function present diagnostic challenges due to the potential presence of associated non diabetic renal disease. Kidney biopsy is essential for PH diagnosis. Understanding of different types non diabetic renal disease in T2DM patients is necessary to improve future patient's outcomes.