Endocrinol Japon
1992, 39 (4), 397-400
Insulin Dependent Nephrocalcinosis
Diabetes and Renal
Mellitus Failure
Accompanied
by
HIROKOKODAMA, TOSHIHIROKURAMATSU, MASAYOSHI YANAGISAWA, TETSUUCHIYA*, AND ATSUSHITAKAHASHI** Departmentof Pediatrics,Jichi MedicalSchool,Tochigi329-11, *DepartmentofPediatrics, Mito SaiseikaiHospital,Ibaragi 311-41, and **DepartmentofPathology,Jichi MedicalSchool, Tochigi329-11, Japan
Abstract. Renal failure was found in a five-year-old was diagnosed as having insulin dependent diabetes showed
that
pancreas number
were compatible with of crystals in the proximal
salt.
The
his renal
calcium
failure
content
nephrocalcinosis
seems
Key words:
dependent
Insulin
was
caused
by a renal
those of IDDM. tubuli. Staining
of
to be
his
kidneys
caused
diabetes
by
atient who had been treated with insulin since he mellitus (IDDM) at 3 years of age. Laboratory data tubular
was
significantly
hypercalciuria
mellitus,
dysfunction.
The
autopsy
findings
of his
The kidneys were atrophied with an innumerable by Kossa indicated that the crystals contained calcium higher
associated
Nephrocalcinosis,
than
with
Renal
that
of
control.
failure.
(Endocrinol Japon 39: 397-400,
INSULIN
dependent
often associated kidney, which nephrocalcinosis not been reported five-year-old nosis that
diabetes
with cause
with renal in IDDM.
patient resulted
mellitus
(IDDM)
microangiopathy renal failure.
is
of the However,
failure has hitherto We describe here a
with IDDM and in renal failure.
nephrocalci-
mediate diabetes During clinic,
the follow-up period in the out-patient he had no pyelonephritis, proteinuria,
pyuria, hematuria, oliguria, hypotension or diabetic coma. His IDDM seemed to be out of control, because
his
The
patient
Japanese
general months
was a five year
and
four
month
old
boy who had been treated with insulin
serum
8.8
Mean•}SD;
Report
1992)
family and none of his other relatives had mellitus or any kind of renal disease.
between
Case
The
IDDM.
normal,
fatigue before
glycohemoglobin
and
18.6% 4-8%).
level
(13.1•}3.1, He
had
appetite
and sometimes vomiting admission. At admission
output was reasonably good. hydration were observed. His
since he was diagnosed as having IDDM at 3 years of age. When his IDDM was first diagnosed, the
were The
levels
significantly
increased
respectively. 9.6g/dl) and
Mild anemia (RBC: 3,790,000, an increase in the ER (130/h)
found.
was within
of his blood
creatinine Received:
were April
urea
normal.
3,
N (BUN) No
members
and
serum
of his im-
1991
Accepted: June 3, 1992 Correspondence Pediatrics,
Teikyo
Kaga, Itabashi-ku,
to: Dr. Hiroko University,
Tokyo
KODAMA, School
173, Japan.
of
Department Medicine
, 2-11-1
of
WBC
to
116
the normal
loss,
for four the urine
No edema height and
normal. No hepatosplenomegaly levels of BUN and serum
was n=8,
or deweight
was found. creatinine were and
2.7mg/dl,
range.
Hb: were Serum
CRP was negative. Cultures of blood and urine were negative for microorganisms. The serum levels of the total protein, Na, K, Cl, IgG, IgA,
KOHAMA
398
Fig. 1.
IgM,
Crystals in the proximal and eosin. X200).
GOT,
GPT,
alkaline
convoluted
tubuli of the kidney.
phosphatase,
uric
acid,
cholesterol, triglyceride and complements (C3 and C4) were normal. The serum levels of Ca and P were 10.2 and 4.6mg/dl, respectively (normal: Ca: 8.4-10.4mg/dl, P: 2.0-5.0mg/dl). During his stay in the
hospital,
the
serum
levels
of Ca,
P and
Mg
were always normal; neither metabolic acidosis alkalosis was observed; and his blood pressure 98/72mmHg. His fundus had no retinopathy diabetes
mellitus.
His renal
function
tests
nor was of
were
et al.
No hyalinosis
of the glomeruli
or vasa afferens.
acids were and pelvis urography.
within the normal ranges. were not detected by No calcification in his
found by roentgenograms treated with a low protein of insulin and intravenous amino
acids.
57mg/dl. the age
However,
decreased
a hypoglycemic 8 months.
Pathological findings
ml/min and 4% (15min),
cally, Langerhans islets, including were decreased in number, although
respectively.
of ƒÀ2-microglobulin
glucosaminidase
mal
1992, 39 (4), 397-400
Insulin Dependent Nephrocalcinosis
Diabetes and Renal
Mellitus Failure
Accompanied
by
HIROKOKODAMA, TOSHIHIROKURAMATSU, MASAYOSHI YANAGISAWA, TETSUUCHIYA*, AND ATSUSHITAKAHASHI** Departmentof Pediatrics,Jichi MedicalSchool,Tochigi329-11, *DepartmentofPediatrics, Mito SaiseikaiHospital,Ibaragi 311-41, and **DepartmentofPathology,Jichi MedicalSchool, Tochigi329-11, Japan
Abstract. Renal failure was found in a five-year-old was diagnosed as having insulin dependent diabetes showed
that
pancreas number
were compatible with of crystals in the proximal
salt.
The
his renal
calcium
failure
content
nephrocalcinosis
seems
Key words:
dependent
Insulin
was
caused
by a renal
those of IDDM. tubuli. Staining
of
to be
his
kidneys
caused
diabetes
by
atient who had been treated with insulin since he mellitus (IDDM) at 3 years of age. Laboratory data tubular
was
significantly
hypercalciuria
mellitus,
dysfunction.
The
autopsy
findings
of his
The kidneys were atrophied with an innumerable by Kossa indicated that the crystals contained calcium higher
associated
Nephrocalcinosis,
than
with
Renal
that
of
control.
failure.
(Endocrinol Japon 39: 397-400,
INSULIN
dependent
often associated kidney, which nephrocalcinosis not been reported five-year-old nosis that
diabetes
with cause
with renal in IDDM.
patient resulted
mellitus
(IDDM)
microangiopathy renal failure.
is
of the However,
failure has hitherto We describe here a
with IDDM and in renal failure.
nephrocalci-
mediate diabetes During clinic,
the follow-up period in the out-patient he had no pyelonephritis, proteinuria,
pyuria, hematuria, oliguria, hypotension or diabetic coma. His IDDM seemed to be out of control, because
his
The
patient
Japanese
general months
was a five year
and
four
month
old
boy who had been treated with insulin
serum
8.8
Mean•}SD;
Report
1992)
family and none of his other relatives had mellitus or any kind of renal disease.
between
Case
The
IDDM.
normal,
fatigue before
glycohemoglobin
and
18.6% 4-8%).
level
(13.1•}3.1, He
had
appetite
and sometimes vomiting admission. At admission
output was reasonably good. hydration were observed. His
since he was diagnosed as having IDDM at 3 years of age. When his IDDM was first diagnosed, the
were The
levels
significantly
increased
respectively. 9.6g/dl) and
Mild anemia (RBC: 3,790,000, an increase in the ER (130/h)
found.
was within
of his blood
creatinine Received:
were April
urea
normal.
3,
N (BUN) No
members
and
serum
of his im-
1991
Accepted: June 3, 1992 Correspondence Pediatrics,
Teikyo
Kaga, Itabashi-ku,
to: Dr. Hiroko University,
Tokyo
KODAMA, School
173, Japan.
of
Department Medicine
, 2-11-1
of
WBC
to
116
the normal
loss,
for four the urine
No edema height and
normal. No hepatosplenomegaly levels of BUN and serum
was n=8,
or deweight
was found. creatinine were and
2.7mg/dl,
range.
Hb: were Serum
CRP was negative. Cultures of blood and urine were negative for microorganisms. The serum levels of the total protein, Na, K, Cl, IgG, IgA,
KOHAMA
398
Fig. 1.
IgM,
Crystals in the proximal and eosin. X200).
GOT,
GPT,
alkaline
convoluted
tubuli of the kidney.
phosphatase,
uric
acid,
cholesterol, triglyceride and complements (C3 and C4) were normal. The serum levels of Ca and P were 10.2 and 4.6mg/dl, respectively (normal: Ca: 8.4-10.4mg/dl, P: 2.0-5.0mg/dl). During his stay in the
hospital,
the
serum
levels
of Ca,
P and
Mg
were always normal; neither metabolic acidosis alkalosis was observed; and his blood pressure 98/72mmHg. His fundus had no retinopathy diabetes
mellitus.
His renal
function
tests
nor was of
were
et al.
No hyalinosis
of the glomeruli
or vasa afferens.
acids were and pelvis urography.
within the normal ranges. were not detected by No calcification in his
found by roentgenograms treated with a low protein of insulin and intravenous amino
acids.
57mg/dl. the age
However,
decreased
a hypoglycemic 8 months.
Pathological findings
ml/min and 4% (15min),
cally, Langerhans islets, including were decreased in number, although
respectively.
of ƒÀ2-microglobulin
glucosaminidase
mal
