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specially in tubular cells [Figure 1.D]. Carotid doppler showed atherosclerosis with 50% stenosis on the right side and 60% on the left side. In view of refractory anasarca not responding to high dose of diuretic, regular ultrafiltration was initiated. Improvement of the fluid overload was achieved but patient still suffer muscle pain, weakness, and intermittent air hunger. Which improved after L-carnitin was added to improve the mitochondrial metabolism.Methods: -Results: -Conclusions: we report a rare case of podocytopathy associated with advanced diabetic nephropathy in type II DM that suggesting acquired mitochondrial cytopathy.

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