| Literature DB >> 19639018 |
Julien Zuber1, Christine Bellanné-Chantelot, Claire Carette, Guillaume Canaud, Sandrine Gobrecht, Khaled Gaha, Vincent Mallet, Frank Martinez, Eric Thervet, José Timsit, Christophe Legendre, Danièle Dubois-Laforgue.
Abstract
BACKGROUND: A 37-year-old man developed cholestasis-associated pruritus followed by overt hyperglycemia (blood glucose level 23 mmol/l), necessitating insulin treatment, within weeks of undergoing renal transplantation. He had a history of gout, but his fasting blood glucose and glycated hemoglobin concentrations had been normal before transplantation. INVESTIGATIONS: Physical examination; laboratory tests, including assessment of glycated hemoglobin, anti-glutamic-acid-decarboxylase and anti-islet-antigen-2 antibodies, liver enzymes, renal function, tacrolimus blood trough level, exocrine (fecal elastase) and endocrine (C-peptide) pancreatic function; abdominal CT scan; liver biopsy; and screening of the hepatocyte nuclear factor 1 homeobox B (transcription factor 2) gene, HNF1B. DIAGNOSIS: New-onset diabetes after transplantation associated with a newly described deletion in HNF1B. MANAGEMENT: Minimization of tacrolimus exposure and withdrawal of steroids considerably reduced the patient's insulin requirement, and cholestasis-related pruritus was dramatically improved by administration of ursodeoxycholic acid. Renal ultrasonography and screening for the HNF1B molecular abnormality were offered to the patient's relatives.Entities:
Mesh：
Substances：
Year: 2009 PMID： 19639018 DOI： 10.1038/nrneph.2009.98
Source DB: PubMed Journal: Nat Rev Nephrol ISSN： 1759-5061 Impact factor: 28.314