Chronic renal failure secondary to diabetes mellitus

Abstract

Introduction Diabetes mellitus (DM) is the most common cause of renal failure. Even when diabetes is controlled, the disease can lead to chronic renal failure (CRF). A patient with CRF failure always undergoes either dialysis or renal transplantation, which both are very expensive financially. Testing in patients with CRF typically includes a complete blood count (CBC), basic metabolic panel, and urinalysis, with calculation of renal function. Renal ultrasonography is the initial imaging modality in the diagnosis of CRF, where features of atrophied, echogenic kidneys with poor cortico-medullary differentiation always observed. The aim of this case report was to focus on role of ultrasound imaging in the work-up of chronic renal failure. Case Report A forty eight years old male, with 22 years history of type 2 DM complains of CRF primarily due to diabetic nephropathy, was admitted to the hospital for dialysis. The patient had been undergoing hemodialysis 3 times per week. On physical examination he was in a fair condition. Laboratory investigation revealed an increased level of creatinine 6.9 mg/dl (<1.5 mg/dl) and blood urea nitrogen (BUN) 49 mg/dl (10-20 mg/dl) were noted. Normal levels for sodium 140 mg/dl (136-145 mg/dl) was detected, but there was an increased level of potassium 7 mg/dl (3.5-5 mg/dl), calcium 11.9 mg/dl (9-10.5 mg/dl), and phosphorus 5.8 mg/dl (3-4.5 mg/dl). Abdominal ultrasound scanning presented sonographic features compatible with CRF as bilateral renal atrophy, poor cortico-medullary differentiation, and increased renal echogenicity. Conclusion Morphological parameters as bilateral renal size, parenchymal thickness, and renal echogenicity can influence further diagnostic and therapeutic interventions of CRF.