Diabetic kidney disease is a very prevalent complication in the context of type 2 diabetes. However, there is evidence showing a high variability in diagnosis when a kidney biopsy is performed. We present a case of a woman with a diagnosis of diabetic kidney disease, systemic arterial hypertension, obesity, and a high risk of progression of chronic kidney disease who presented with a sudden onset nephrotic syndrome and rapidly progressive deterioration of renal function. Kidney biopsy revealed pauci-immune extracapillary glomerulonephritis with acute thrombotic microangiopathy and class IIa diabetic nephropathy. Antineutrophil cytoplasmic antibodies (ANCA) and low complement were detected. The patient received treatment based on plasma exchanges, steroids with methylprednisolone and prednisone and intravenous cyclophosphamide with improvement of renal function. In conclusion, expansion of kidney biopsy criteria in patients with a diagnosis of type 2 diabetes is mandatory to provide adequate treatment and prognosis in the context of a high prevalence of alternative or concomitant disease.
Keywords: adult nephrotic syndrome; anca-associated vasculitis; diabetic nephropathies; image-guided biopsy; pauci-immune crescentic glomerulonephritis.
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