Endocrine Abstracts

Diabetic nephropathy is the leading cause of chronic kidney disease and is responsible for 30–40% of all end stage renal disease (1). Where there is rapid decline in eGFR, we should also consider other aetiologies.

This is the case of a 65-year-old Caucasian gentleman with complex presentation and novel management strategy with type 2 diabetes mellitus since 1999 which was effectively managed, evident by reasonable control of HBA1c; Pharmacotherapy regimen was modulated sensitive to patient tolerability and outcome. On subsequent follow up his creatinine was 389 umol/l from baseline of around 160 umol/l. When patient was informed of possibility of dialysis over coming year, it caused him severe anxiety. During history taking, it was revealed that the patient had an episode of anterior uveitis. Thorough physical examination led to the discovery of an erythematous lesion on his left shin, and meticulous review of laboratory findings revealed intermittent hypercalcemia. This triad of observations led to discover shadowing, suspicious of hilar lymphadenopathy on chest X-ray: Hence moderate-dose prednisolone therapy was initiated for presumptive sarcoidosis; Biopsy was precluded due to body habitus. Corticosteroids provided a rapid return of creatinine to baseline, however, necessitated introduction of insulin due to induction of hyperglycaemia. On subsequent commencement of azathioprine, prednisolone dosages were rapidly reduced, and insulin requirement were significantly reduced.

Conclusion: Encourage physicians to consider alternative aetiologies to diabetic nephropathy for rather swift deterioration of renal function in patient with diabetes, such as renal sarcoidosis. Secondly, rapid withdrawal of moderate-dose corticosteroids and substitution with a steroid-sparing agent as a novel therapeutic modality for treatment of renal sarcoidosis in the setting of diabetes mellitus was superior to the established protocol (2, 3). This sequential pharmacotherapy has preserved quality of life, as renal failure requiring long-term haemodialysis was imminent, and corticosteroid withdrawal allowed for continuing better glycaemic control.