SUN-437 PODOCYTOPATHY IN TYPE 2 DIABETES MELLITUS: A CASE REPORT AND REVIEW OF LITERATURES

Abstract

The association of Per-hilar FSGS with type 2 diabetes is not uncommon and represent a form of podocytopathy. Several reports have shown various primary glomerulonephritis can be superimposed on diabetic nephropathy. The appearance of urinary abnormalities or deterioration in renal function inconsistent with natural history of diabetic nephropathy raises the possibility of nondiabetic renal disease and should lead to a more detailed evaluation. The association of podocytopathy in the form of heavy proteinuria, muscle weakness and arteriolopathy suggest mitochondrial cytopathy. Case report: A 60 year-old male patient with type 2 diabetes presented with high serum creatinine 3.5 mg/dl, heavy proteinuria 13.6 gm/day, serum albumin 1.07 gm/dl, high serum cholesterol 288 mg/dl, anemia of chronic disease HB 8 gm/l, recurrent cerebral stroke, generalized muscle pain and atrophy in the upper and lower muscle girdle, intermittent air hunger, poor oral nutrition and generalized anasarca with poor response to diuretic therapy, GFR was 16 ml/min. Renal biopsy was done and revealed per-hilar FSGS [Figure 1.A], mesangial sclerosis [Figure 1.B]. Electron microscopy revealed podocyte foot process effacement [Figure 1.C] and occasional mitochondria displaying abnormal internal structure specially in tubular cells [Figure 1.D]. Carotid doppler showed atherosclerosis with 50% stenosis on the right side and 60% on the left side. In view of refractory anasarca not responding to high dose of diuretic, regular ultrafiltration was initiated. Improvement of the fluid overload was achieved but patient still suffer muscle pain, weakness, and intermittent air hunger. Which improved after L-carnitin was added to improve the mitochondrial metabolism. - - we report a rare case of podocytopathy associated with advanced diabetic nephropathy in type II DM that suggesting acquired mitochondrial cytopathy.