4. A 42-year-old woman who has had proteinuria for about 5 years develops renal

Question

4. A 42-year-old woman who has had proteinuria for about 5 years develops renal failure. She also has developed hypertension and has had several bacterial and vaginal yeast infections over the last 10 years. Her two pregnancies were uncomplicated, although she required cesarean deliveries for large babies of 9 pounds and 9.5 pounds. A kidney biopsy reveals increased mesangial matrix and accellular periodic acid-Schiff (PAS) postive nodules. What is the most likely diagnosis? What is the underlying mechanism?

Explanation / Answer

The patient is suffering from diabetic glomerulosclerosis that causes Nephrotic syndrome. Nephrotic syndrome is a kidney disease that is commonly observed in most of the diabetic patients suffering from chronic diabetes. High protein excretion in the urine (proteinurea) and edema are the common diagnostic observations of nephritic syndrome. These patients are also likely to suffer from hypertension due to activated rennin-angiotensin system in response to decreased fluid volume. The underlying mechanism is microangiopathic changes that occur in glomerulus due to chronic hyperglycemia.

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