Diabetic nephropathy masquerading as systemic disease: The critical role of renal biopsy in a young uninsured woman with nephrotic syndrome

Authors

• Yolanda V. Gutierrez, University of Texas Rio Grande ValleyFollow
• Alexis Vargas Del Toro, The University of Texas Rio Grande Valley
• Cristina Kochi Yamamoto, The University of Texas Rio Grande Valley
• Jose Loayza Pintado, The University of Texas Rio Grande ValleyFollow
• Andres Suarez-Parraga, The University of Texas Rio Grande ValleyFollow

Document Type

Article

Publication Date

5-4-2026

Abstract

Nephrotic syndrome can have overlapping features across multiple diseases, making diagnosis difficult without tissue confirmation. We describe a 30-year-old uninsured Hispanic woman with type 1 diabetes, hypertension, and CKD3B who presented with nephrotic syndrome, sepsis, and progressive muscle weakness. Her pleural effusions, periorbital changes, elevated free light chains, and dysphagia raised concern for systemic conditions such as amyloidosis or polymyositis, especially given inconsistent outpatient follow-up. Because her management would differ significantly depending on the underlying cause and due to the high risk of loss to follow-up, a renal biopsy was pursued. Serologic studies were unremarkable, and biopsy ultimately confirmed diabetic nephrosclerosis. This case highlights how clinical findings alone may be misleading in diabetic patients with heavy proteinuria. Renal biopsy remains the most reliable tool for distinguishing diabetic nephropathy from other systemic diseases. An individualized approach that considers comorbidities and social determinants of health is essential for accurate diagnosis and care.

Comments

© The Author(s) 2026 , Article Reuse Guidelines  

Recommended Citation

Gutierrez, Y. V., Vargas Del Toro, A., Kochi Yamamoto, C., Loayza Pintado, J., & Suarez Parraga, A. (2026). Diabetic nephropathy masquerading as systemic disease: The critical role of renal biopsy in a young uninsured woman with nephrotic syndrome. Sage Open Medical Case Reports, 14, 2050313X261448376. https://doi.org/10.1177/2050313X261448376

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Publication Title

Sage Open Medical Case Reports

DOI

10.1177/2050313X261448376

Academic Level

faculty

Mentor/PI Department

Internal Medicine