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논문분류	춘계학술대회 초록집
제목	Reversibility of Histologically Documented Tubular Necrosis Observed in Diabetic Nephropathy: A Series Six Case Reports
저자	Seung Yeon Son1, Ghee Young Kwon2, Hye Ryoun Jang1, Jung Eun Lee1, Wooseong Huh1, Yoon-Goo Kim1, Dae Joong Kim1, Ha Young Oh1
출판정보	2015; 2015(1):
키워드	급성 세뇨관 괴사,당뇨병성 신증,가역성
초록	Backgroud: Acute tubular necrosis (ATN) is a classically reversible disease entity. However, it cannot be assure full recovery particularly in elderly and in subjects with chronic kidney disease (CKD). Recent epidemiologic study has revealed that acute kidney injury episodes are associated with a risk for developing advanced CKD in diabetes. In this study, we aimed to evaulate if histologically documented tubular necrosis accompanied by diabetic nephropathy was associated with subsequent renal function recovery. Methods: From January 2009 to January 2013, among 852 patients who underwent kidney biopsy, 79 patients were diagnosed as having diabetic nephropathy. After exclusion of patients combined with other glomerulonephritis or interstitial nephritis, ATN accompanied by diabetic nephropathy was identified in 6 patients. We retrospectively reviewed the clinical course in these 6 patients. Results: As a result, the mean age was 56±10 years and male patients were 4 of 6 patients. The mean duration of diabetes was 16.3±8.6 years and the median initial serum HbA1c was 6.8±2.4%. The indications for biopsy were progressive azotemia in all cases. At the time of biopsy, the mean serum creatinine level was 2.9±0.6 mg/dL, and spot urine protein to creatinine ratio was 5.3±3.9 g/g Cr. All six kidney specimens were compatible with diabetic nephropathy and were accompanied by various stages of tubular necrosis: acute tubular damage in 3 cases, subacute tubular damage in 1 case and subacute with chronic tubular damage in 2 cases. Despite of proper management for ATN, renal function was not improved at 3 months after kidney biopsy at all in 6 patients showing a progressive decline of estimated glomerular filtration rate. In addition, 2 patients progressed to end-stage renal disease at 2, 4 months after kidney biopsy, respectively. Conclusions: This case-series suggests that tubular necrosis accompanied by diabetic nephropathy would not be reversible, even in case it seems acute lesion. The pathogenesis of tubular necrosis observed in diabetic nephropathy should be evaluated in further studies.
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