A Rare Case of Crescentic Diabetic Nephropathy

Document Type

Conference Proceeding

Publication Date

4-2025

Publication Title

American Journal of Kidney Diseases

Abstract

Diabetic Nephropathy (DN) is a common complication of uncontrolled Diabetes Mellitus (DM), with a prevalence of 28.2% among diabetics in North America (1). Typical histological features of DN include glomerular basement membrane (GBM) thickening, mesangial expansion, and nodular to diffuse glomerulosclerosis. This case presents a rare instance of crescentic DN, which rapidly progressed to renal failure. A 25-year-old female with uncontrolled Type 1 DM and resistant hypertension presented with lower leg edema and dyspnea. Initial labs revealed elevated creatinine (5.81 mg/dL, baseline 1.1mg/dL), nephrotic-range proteinuria (urine protein to creatinine ratio 17.95), BUN 54 mg/dL, HbA1C 11.4, hemoglobin 9.6 g/dL, and non-anion gap metabolic acidosis. Computed Tomography Abdomen Pelvis showed diffuse intraabdominal and subcutaneous anasarca, consistent with signs of volume overload on physical examination. Renal ultrasound revealed bilateral renal disease. HIV, hepatitis serologies, serum protein electrophoresis, and autoimmune workup including anti-neutrophil cytoplasmic (ANCA), proteinase 3, anti-GBM, IgA and myeloperoxidase antibody were negative. Despite receiving intravenous furosemide, her urine output remained suboptimal and a renal biopsy was performed due to worsening renal function; hemodialysis was initiated. The preliminary biopsy revealed crescents suggestive of rapidly progressive glomerulonephritis (RPGN), and she was given high-dose methylprednisolone followed by a prednisone taper. Final biopsy showed moderate interstitial fibrosis, tubular atrophy, glomerular sclerosis, fibrocellular crescents, and DN changes, suggesting pauci-immune ANCA-negative glomerulonephritis superimposed on DM, versus crescentic DN. She was discharged on outpatient hemodialysis, with transplant nephrology follow-up and has recently been deemed a suitable candidate for kidney transplant. Crescents on histopathology are usually a hallmark of RPGN, however this case shows that these can also be observed in DN, and serve as an important marker of impeding renal failure in such patients. Delays in diagnosis of this finding should be avoided to allow for timely intervention and to prevent progression to end-stage-renal-disease. Prompt renal biopsy should be considered in atypical cases of presumed DN.

Volume

85

Issue

4 Suppl 1

First Page

S52

Comments

National Kidney Foundation 2025 Spring Clinical Meeting, April 9-13, 2025, Boston, MA

Last Page

S53

DOI

10.1053/j.ajkd.2025.02.166

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