RAPID-ONSET DIABETIC NEPHROPATHY IN TYPE-II DIABETES-MELLITUS

We report a case of rapidly progressive diabetic nephropathy, from lit tle diabetic change on renal biopsy to severe, nodular diabetic nephro sclerosis over 32 months. The patient was taking an angiotensin conver ting enzyme inhibitor and had a mean arterial pressure of 95 mm Hg ove r this time period. Her dietary protein intake was low, at least upon presentation. She had three additional mechanisms or potential mechani sms of injury: monoclonal kappa light chains; IgA immune deposits on t he first, but not the second biopsy; and longstanding hypertension. He r renal histology was typical for diabetic nephropathy but was not cha racteristic of kappa light chain disease. We suggest that diabetic nep hropathy may develop more rapidly than previously assumed, especially when additional mechanisms of injury, or additional promoters of mesan gial matrix accumulation are present.