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June 16, 2017

Minimal Change Disease and New Onset DM type I

AN ODD COINCIDENCE? OR ARE THEY RELATED?

This biopsy is from a teenager who had a viral illness 6 weeks ago. Five weeks ago, he developed polyphagia and polydipsia and was found to have new onset Type I Diabetes Mellitus. One week prior to renal biopsy, he had the sudden onset of facial edema and a urine protein/creatinine ratio of 7.8.

Image 1. No change by light microscopy.
Image 2. Diffuse and complete foot process effacement.

Diagnosis: Minimal Change Disease
Simultaneous occurrence of Type 1 Diabetes and Minimal Change Disease has been reported. Here is a link to a case report of two patients: https://www.ncbi.nlm.nih.gov/pubmed/22798086 and another link to treatment of 4 patients with this interesting anomaly: https://www.ncbi.nlm.nih.gov/pubmed/12042892

The link between DM1 and MCD is higher than would be expected according to the estimated prevalence rates for each disease separately. Managing steroid therapy in such patients can be difficult and Goldman et al have specific treatment recommendations (2).

References:
1. Simultaneous onset of steroid-resistant nephrotic syndrome and IDDM in two young children. Kari JA, El-Desoky SM, Mokhtar G, Jalalah SM. BMJ Case Rep. 2010 Nov 29;2010. pii: bcr0420102916. doi: 10.1136/bcr.04.2010.2916. PMID: 22798086 Free PMC Article

2. Management of steroid-sensitive nephrotic syndrome in children with type 1 diabetes. Goldman M, Hébert D, Geary DF. Pediatr Nephrol. 2002 May;17(5):351-4. PMID: 12042892