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Progression of diabetic nephropathy after successful pancreas transplantation alone: a case report

대한이식학회지 2019년 33권 4호 p.146 ~ 152
 ( Kim Yoon-Hong ) - Pusan National University School of Medicine Pusan National University Yangsan Hospital Department of Surgery

김동일 ( Kim Dong-Il ) - Pusan National University School of Medicine Pusan National University Yangsan Hospital Department of Surgery
 ( Shim Jae-Ryong ) - Pusan National University School of Medicine Pusan National University Yangsan Hospital Department of Surgery
이태범 ( Lee Tae-Beom ) - Pusan National University School of Medicine Pusan National University Yangsan Hospital Department of Surgery
양광호 ( Yang Kwang-Ho ) - Pusan National University School of Medicine Pusan National University Yangsan Hospital Department of Surgery
류제호 ( Ryu Je-Ho ) - Pusan National University School of Medicine Pusan National University Yangsan Hospital Department of Surgery
이현정 ( Lee Hyun-Jung ) - Pusan National University School of Medicine Pusan National University Yangsan Hospital Department of Pathology
최병현 ( Choi Byung-Hyun ) - Pusan National University School of Medicine Pusan National University Yangsan Hospital Department of Surgery

Abstract


Pancreas transplantation is the only method that can nearly cure insulin-dependent diabetes mellitus. However, the effect of pancreas transplantation on patients with diabetic nephropathy has recently been considered controversial. In this report, we present a case of abrupt aggravation of proteinuria after successful pancreas transplantation alone without evidence of calcineurin inhibitor (CNI) toxicity. A 22-year-old female patient with type I diabetes mellitus underwent pancreas transplantation alone. The patient already had retinopathy and mild proteinuria, which in this case, may mean diabetic nephropathy. Her glucose levels were managed within the normal range after successful pancreas transplantation. However, the amount of proteinuria fluctuated. Kidney needle biopsy was performed owing to severe elevation of proteinuria, 2 years after the transplantation. Electron microscopy revealed diabetic glomerulosclerosis without evidence of CNI toxicity. This case indicates that diabetic nephropathy can be aggravated after pancreas transplantation, despite well-managed glucose levels and absence of CNI toxicity.

키워드

Pancreas transplantation; Diabetic nephropathies; Calcineurin inhibitors
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