STABLE RENAL-FUNCTION IN INSULIN-DEPENDENT DIABETES-MELLITUS 10 YEARSAFTER NEPHROTIC RANGE PROTEINURIA

It has been considered unlikely that patients with insulin-dependent d iabetes and diabetic nephropathy with nephrotic range proteinuria can substantially reduce proteinuria and continue for many years without f urther loss of renal function. We present a patient who had the diagno sis of insulin-dependent diabetes made at age 15, had his first of 6 l aser treatments for proliferative and hemorrhagic retinopathy at age 2 7 and was found to have nephrotic range proteinuria and edema with hyp ertension at age 29, when results of a renal biopsy were typical of di abetic nephropathy. Ten years later, with the last 5.5 years on ACE in hibitors, proteinuria has been < 0.65 g/24 h for 2 years and recently 0.22 g, serum creatinine is unchanged at 90 to 102 mu mol/l, DTPA GFR is 104 ml/min and retinopathy has remained stable without laser therap y for 7 years. Blood pressure on clinic visits has averaged 126/74 for the last 8 years. This duration of stable renal function and the majo r decrease in proteinuria after being in the neprotic range is very ra re in reports, if not unique.