In recent years, the prognosis for a successful pregnancy has greatly improved for women with insulindependent diabetes mellitus (IDDM) who are under good glycemic control and free of complications such as vascular disease and nephropathy. We report the rapid development of severe nephrotic syndrome, malignant hypertension, and microangiopathic hemolytic anemia during the first trimester of pregnancy in a 29-yr-old woman with IDDM of 18 yr duration. Our patient had no pregestational history of retinopathy or hypertension and only minimal proteinuria. Significant improvement in blood glucose levels had been achieved over the 6 mo before conception. Kidney biopsy performed before the termination of pregnancy at 10 wk gestation revealed diabetic nephropathy. No other etiology for her renal disease could be found. An arteriole was noted to have entrapped red blood cell fragments and platelet thrombi, revealing the probable source of her hemolytic process. By 8 wk postpartum, her nephrotic syndrome and hemolysis had completely resolved. At 3 mo postgestation, the patient's hypertension was still present but less severe. Her serum creatinine has continued to decrease toward normal. This is the first report of a woman with IDDM in White's classification C who developed a toxemia-like syndrome during the first trimester of pregnancy, attributable to the underlying diabetic state.
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Original Articles|
May 01 1988
Rapid Development of Nephrotic Syndrome, Hypertension, and Hemolytic Anemia Early in Pregnancy in Patients With IDDM Free
Ruth S Weinstock, MD, PhD;
Ruth S Weinstock, MD, PhD
Departments of Medicine, Pathology, and Obstetrics and Gynecology, the State University of New York Health Science Center, and the Department of Medicine, Veterans Administration Medical Center
Syracuse, New York
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Richard T Kopecky, MD;
Richard T Kopecky, MD
Departments of Medicine, Pathology, and Obstetrics and Gynecology, the State University of New York Health Science Center, and the Department of Medicine, Veterans Administration Medical Center
Syracuse, New York
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David B Jones, MD;
David B Jones, MD
Departments of Medicine, Pathology, and Obstetrics and Gynecology, the State University of New York Health Science Center, and the Department of Medicine, Veterans Administration Medical Center
Syracuse, New York
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Shiraz Sunderji, MD
Shiraz Sunderji, MD
Departments of Medicine, Pathology, and Obstetrics and Gynecology, the State University of New York Health Science Center, and the Department of Medicine, Veterans Administration Medical Center
Syracuse, New York
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Address correspondence and reprints requests to Ruth S. Weinstock, MD, PhD, Department of Medicine, SUNY Health Science Center, 750 E. Adams Street, Syracuse, NY 13210.
Citation
Ruth S Weinstock, Richard T Kopecky, David B Jones, Shiraz Sunderji; Rapid Development of Nephrotic Syndrome, Hypertension, and Hemolytic Anemia Early in Pregnancy in Patients With IDDM. Diabetes Care 1 May 1988; 11 (5): 416–421. https://doi.org/10.2337/diacare.11.5.416
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