An elderly male w/ DM2 presents with subacute dyspnea, found to be volume overloaded with evidence of nephrotic syndrome, worsening anemia, and newly diagnosed MR. The renal biopsy is pending but currently specialists are favoring the diagnosis of diabetic nephropathy, and we discussed that the MR could be functional (less likely a secondary degenerative process) in the setting of worsening volume overload.
1) Interpret proteinuria with caution in the setting of AKI
2) MR can be degenerative or functional (i.e. occur in the setting of acute change in volume status or heart failure). If functional, the treatment is to address the underlying change and NOT procedural repair.
3) When considering diabetic nephropathy, look at a patient’s A1C trend. Often you’ll notice a rising A1C over years, but then a decline as their renal function worsens (and as insulin starts to hang around). You should also see a progressive increase of their microalbumin urine test.*