ESPE Abstracts

Background: Paediatric nephrotic syndrome has an estimated incidence of 2 per 100,000 children per year and type 1 diabetes had a reported incidence of 9.5 per 100,000 habitants in Portugal (2018 data). To the best of our knowledge, the simultaneous occurrence of nephrotic syndrome and type 1 diabetes is rare – we found 13 published cases in paediatric age worldwide. Clinical case: A 5-year-old boy with personal history of nephrotic syndrome was admitted to the emergency department with complaints of palpebral oedema and proteinuria (+++) in the urine dipstick test. At admission, he was stable, with no alterations in his physical exam besides the palpebral oedema. Urinalysis showed protein (+++) and glycose (++++) by dipstick. He denied polyuria, polydipsia, weight loss and polyphagia. Further blood evaluation reported cetonemia 1.2 mmol/l, HbA1C 8.6%, insulin 2.0 pmol/l and blood gases without alterations. The child was diagnosed with relapsing nephrotic syndrome and inaugural type 1 diabetes without ketoacidosis. Oral prednisolone 60 mg/m²/day and multiple insulin injection therapy were started. It was challenging to maintain glycaemia on the target during corticoid treatment. When he started to take it every other day, our option was to diminish 10% of the basal insulin in the days without corticoid, with satisfactory results (HbA1 7.6%). Eight months after the diagnosis, continuous subcutaneous insulin infusion was initiated, achieving a HbA1C of 6.5% with a total daily dose of insulin of 0,68 IU/kg, without corticoid. In his latest nephrotic syndrome relapse it is reported a better glycaemic control, achieved using temporary basal rates in the insulin pump (HbA1 7.3%). To note that total daily dose of insulin increased to 1,14 IU/kg. In addition to the described, he exhibited positivity for human leucocyte antigen (HLA) DQA1 and DQB1, both associated with DQ2 heterodimer.

Conclusions: The aim of this case is not only to report a new case of nephrotic syndrome and type 1 diabetes mellitus, but also to make known a different approach concerning patients with diabetes mellitus insulin-treated and nephrotic syndrome. We report a better glycaemia control with insulin pump compared to multiple insulin injections in our patient, besides stating our approach during corticosteroid progressive weaning when in multiple insulin injection therapy.