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Case Report

Korean J Transplant 2019; 33(4): 146-152

Published online December 31, 2019

https://doi.org/10.4285/jkstn.2019.33.4.146

© The Korean Society for Transplantation

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

Yoonhong Kim1, Dong Il Kim1, Jae Ryong Shim1, Tae Beom Lee1, Kwang Ho Yang1, Je Ho Ryu1, Hyun Jung Lee2, Byung Hyun Choi1

Departments of 1Surgery and 2Pathology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

Correspondence to: Byung Hyun Choi
Department of Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea
Tel: +82-55-360-2478, Fax: +82-55-360-2154 E-mail: gmoolpop@gmail.com

Received: September 6, 2019; Revised: November 4, 2019; Accepted: November 13, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Pancreas transplantation, Diabetic nephropathies, Calcineurin inhibitors