Case series of nondiabetic kidney disease masked by clinical diabetes: A wolf in sheep’s clothing

Diabetic kidney disease (DKD), one of the most frequent microvascular complications of diabetes, is the leading cause of end stage kidney disease worldwide. However, a significant majority of diabetic patients may have pure non-diabetic kidney disease (NDKD) or NDKD superimposed on DKD. Certain clinical predictors in long standing diabetic patients warrant a renal biopsy, to rule out NDKD. We present 5 cases of non-diabetic kidney disease in rather unusual clinical settings. First case is of a 50-year-old diabetic female with a rapidly progressive renal failure like presentation and a disassociation between urinary dipstick and 24-hour urine protein estimation. Subsequently, patient was diagnosed with light chain cast nephropathy. Next, is a case of 61-year-old male with long standing diabetes and nephrotic range proteinuria, but had no diabetic retinopathy. Eventually, patient was diagnosed with membranous nephropathy. Another case is of a 52-year-old diabetic male, who presented with rapidly progressive renal failure and a positive MPO ANCA titre. Histopathological examination revealed it to be ANCA associated crescentic glomerulonephritis. Fourth case of a 65-year-old diabetic male, with nephritic-nephrotic syndrome like presentation and surprisingly positive MPO ANCA titre, was eventually diagnosed with membranous nephropathy. Final case of 54-year-old diabetic female, with progressive anasarca over 6 months, showed 2+ urinary dipstick but enormously high 24-hour urinary protein. Renal biopsy showed light chain deposition disease. In all 5 cases, diagnosis of NDKD led to change in course of therapy and management, leading to attainment of renal remission.