Diabetic Nephropathy

Abstract

A 31-year-old man, who had become diabetic at age 7, was treated with insulin but did not have good glycémie control. Seven years before being seen at University Hospitals, he had come to the attention of an internist who noted mild hypertension, 140/100 mm Hg, and slight ankle edema. The urinalysis showed 4 + proteinuria, 1+ glucosuria, and one to three red cells per high power field. Laboratory studies at that time were as follows: hemoglobin 14.6 g/dl, hematocrit 44.1 percent, blood urea nitrogen (BUN) 7 mg/dl, creatinine 0.7 mg/dl, potassium 4.6 mEq/L, sodium 140 mEq/liter, chloride 116 mg/dl, CO₂ 30 mEq/liter, serum albumin 4.8 g/dl, calcium 4.6 mEq/liter, and uric acid 5.5 mg/dl. A 24-hour urine collection contained 4.4 g of protein. The patient’s physician recommended improved blood sugar regulation, and added hydrochlorothiazide, 25 mg daily, for blood pressure control. The patient did not return for follow-up.