Diabetic nephropathy is a common and serious complication of diabetes characterized by persistent proteinuria, hypertension and a progressive decline of renal function. However, non-diabetic renal disease can be present in diabetic patients and differential diagnosis of treatable disease is important. Minimal change nephrotic syndrome is characterized by normal light microscopic finding and effacement of foot process in electron microscope, but foot process effacement is not specific and it can be present in the glomeruli of the most glomerulopathy including diabetic nephropathy. Therefore, pathologic diagnosis of minimal change nephrotic syndrome combined with diabetic nephropathy is very difficult. However, we could exclude other glomerulopathy and diagnose minimal change nephrotic syndrome by clinical features in three type 2 diabetic patients with diabetic nephropathy and have successfully treated with corticosteroid.
Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Diagnosis, Differential ; Electrons ; Foot ; Humans ; Hypertension ; Light ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Proteinuria

Membranous glomerulopathy (MGN) is a common cause of nephrotic syndrome in adults. Renal failure gradually develops in patients with MGN and crescentic glomerulonephritis (CGN) superimposed on MGN is a rare cause of acute renal failure. In most cases patients showed nephrotic syndrome with acute renal failure. We report a 33-year-old woman with azotemia but with no other symptoms such as nephrotic syndrome she had been diagnosed to have MGN 15 months before. There seemed to be no other cause of azotemia. Renal biopsy was performed and revealed CGN on existing MGN. She was treated with immunosuppression treatment and azotemia was improved. When unexplained azotemia develops in patients with MGN, we should promptly investigate superimposed conditions including CGN. In CGN superimposed on MN, a potentially reversible condition with appropriate immunosuppression therapy should be considered.
Acute Kidney Injury ; Adult ; Azotemia ; Biopsy ; Female ; Glomerulonephritis ; Glomerulonephritis, Membranous ; Humans ; Immunosuppression ; Nephrotic Syndrome ; Renal Insufficiency