Idiopathic Membranous Glomerulonephritis in Diabetic Patients: Report of Three Cases and Review of the Literature

Three adults with diabetes mellitus and nephrotic syndrome of recent onset underwent renal biopsies because of certain unusual clinical features. Despite heavy proteinuria, one patient had no evidence of diabetic retinopathy, one had preservation of normal renal function, while the third had sudden onset of renal failure. Microscopic examination of renal biopsy material disclosed pure membranous nephropathy in one, membranous nephropathy and nodular glomerulosclerosis in two. Because of significant differences in the natural history of these two glomerulopathies and the possible beneficial effects of steroid therapy in membranous nephropathy, we suggest that renal biopsies be performed in diabetic patients having persistent hematuria, sudden onset of renal failure, massive proteinuria without azotemia, retinopathy, or other evidence of microvascular disease, to uncover superimposed and treatable disorders that may influence the course of renal disease.