Renal Dysfunction Worsened by Superimposition of IgA Glomerulonephritis in a Patient with Overt Diabetic Nephropathy

Abstract

The combination of glomerulonephritis and diabetes nephropathy has been reported to occur in 1.8–22% of biopsy-proven diabetic nephropathy cases [1–6]. In these reports, however, the onset of glomerulonephritis during the course of diabetic nephropathy was not described in detail, and how the superimposition of glomerulonephritis affected renal function, particularly at the advanced stage of diabetic nephropathy. We recently encountered a patient, in whom the onset of IgA glomerulonephritis was detected clinically during the advanced stage of overt diabetic nephropathy. In this case, the onset of glomerulonephritis significantly increased the progressive deterioration of renal function.

Nondiabetic Renal Disease in Type 2 Diabetic Patients: A Review of our Experience in 220 Cases

“…But a few reports have documented a rapid deterioration of renal function in patients with superimposed IgA nephropathy on top of DN, and diabetic microvascular complications are also worsened by superimposition of IgA nephropathy. 26,27 Because the inclusion criteria for renal biopsy in these retrospective series have included atypical clinical course like rapid loss of renal function among diabetic patients with renal involvement, selection bias leading to IgA nephropathy patients with aggressive renal outcome being picked up is a distinct possibility. It is apparent that only by prospectively recruiting type 2 diabetic patients with defined criteria for renal biopsy, although subsequently observing the clinical course of these patients, could one determine the true difference between the outcome of patients with DGS alone and those with superimposed IgA nephropathy.…”

Proteins in human body fluids contain in vivo antigen analog of the melibiose-derived glycation product: MAGE

“…Glycation is also a suspected cause of decreased elimination of IgA by the liver and the protein accumulation in blood 83 . Serum IgA levels are significantly higher in diabetic patients than in healthy subjects 84 – 86 . High levels of IgA is a sign of diabetic nephropathy 86 , the most commonly recognized type of glomerular disease in the world and manifested by the formation of mesangial IgA deposits 87 .…”

Elevation of Serum IgA Is of Little Diagnostic Utility in Patients with Type 2 Diabetes mellitus and Nephropathy

“…Dear Sir, Kawasaki et al [1] recently reported that IgA nephropathy (IgAN) can aggravate the pace of progression towards renal insufficiency in patients with type 2 diabetes and proteinuria. It is now accepted that nondiabetic nephropathies sometimes superimposed upon diabetic glomerulosclerosis are much more frequent in non-insulin-dependent diabetes mellitus patients (NIDDM) than in insulin-dependent diabetes mellitus patients with proteinuria [2].…”