The nephrotic syndrome at presentation of insulin-dependent diabetes mellitus; cause or coincidence?

Two young women developed the nephrotic syndrome within 2 weeks of presenting with diabetes and starting insulin. One had a renal biopsy which showed changes consistent with 'minimal change nephrotic syndrome' on electron microscopy but no evidence of diabetic glomerulosclerosis. Neither patient received steroids; in one the oedema resolved spontaneously but the other required diuretics. This patient also had severe IgA-deficiency probably associated with epilepsy and/or phenytoin therapy and unrelated to the pathogenesis of the nephrotic syndrome. The nephrotic syndrome may rarely present coincidentally with, or soon after, insulin-dependent diabetes mellitus (IDDM). It must be distinguished from 'insulin oedema' and classical diabetic nephropathy which occurs later in the course of IDDM. All reported cases have either remitted spontaneously or responded to steroids.