Abstract
Background: The incidence of non-diabetic renal disease is very high in type 2 diabetic patients. Systemic amyloidosis as one of the non-diabetic renal disease rarely occur in type 2 diabetes mellitus subjects and may have the high risk of early mortality. Case report and management: We report a case in a 66-year-old patient with legs edema, inappetence and frothy urine for 2 weeks. The patient was diagnosed type 2 diabetes on routine testing 10 years ago without any symptoms. The blood glucose was adequately controlled with diet and exercise. Physical examination showed edema of lower extremities and hepatomegaly. 24 hrs urinary protein was 4.7 g. Blood investigation showed slightly impaired liver function while other results incluing serological studies and bone marrow aspirate showed negative or in normal range. Funduscopy showed normal retinal blood vessels and optic disc. Echocardiography revealed cardiac amyloidosis with septal hypertrophy and the ultrasound scan revealed hepatomegaly. Hepatic biopsy was performed and diagnosis of systemic amyloidosis was made due to positive congo red staining. Conclusions: When massive proteinuria occurred in patient with type 2 diabetes and other internal organs like liver and heart are affected, superimposed systemic amyloidosis should be considered in particular
Highlights
It is estimated that about 20%-40% of patients with type 1 or type 2 diabetes will develop diabetic nephropathy (DN), which contributes to most end-stage renal disease worldwide [1,2]
Diagnosis of DN is mostly clinically based on a long history of diabetes, proteinuria, hypertension, and a progressive decline in renal function
We describe a rare case of type 2 diabetes presenting with massive proteinuria due to primary systemic amyloidosis
Summary
When massive proteinuria occurred in patient with type 2 diabetes and other internal organs like liver and heart are affected, superimposed systemic amyloidosis should be considered in particular. Renal Disease; ALT: Alanine Aminotransferase; AST: Aspartate Aminotransferase; T2DM; Type 2 Diabetes Mellitus
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