Abstract
AbstractThis clinical case shows bad household between diabetes and kidney, and when arterial hypertension gets in the way! A woman with diabetes for a long time and treated with metformin presents metabolic syndrome with type 2 diabetes, arterial hypertension difficultly controlled by antihypertensive drugs, dyslipidaemia and chronic kidney failure (CKF) which worsens regularly. Gradually, glucose in excess in blood plasma glycosylates renal glomerular membranes meaning to diabetes nephropathy, which can be revealed by a nephrotic syndrome, no pure as in the present case with an arterial hypertension resistant to therapy. Acute kidney failure crisis is in the frame of CKF, which worsens with decline of glomerular filtration rate (GFR), large increase in albuminuria and heavy antihypertensive therapy. Vicious circle sets in because CKF increases arterial tension meaning to enhance antihypertensive therapy itself toxic for the kidney. To break this vicious circle, on the one hand we have to better control diabetes and on the other hand, to control hypertension by choosing drugs protective for the kidney. Every new decrease in GFR or increase in albuminuria makes you fear of a new acute renal failure crisis that you have to take care quickly. Diabetes is the main cause of renal transplantation.
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