Clinico-pathological features of postural hypotension in diabetic autonomic neuropathy

We report the clinico-pathological features and management of a 49-year-old male with a 30-year history of Type 1 diabetes mellitus who had nephropath y (proteinuria 1.81 g/24 h, creatinine 136 mu mol/l), proliferative retinop athy and severe somatic and autonomic neuropathy. A sural nerve biopsy demo nstrated marked myelinated fibre loss with unmyelinated fibre degeneration and regeneration combined with extensive endoneurial microangiopathy. The m anagement of the patient's blood pressure problems (supine hypertension) an d symptomatic postural hypotension is discussed.