|It has been demonstrated in several observational studies that hyperglycemia is an important risk factor for development of microvascular complications in patients with type 2 diabetes mellitus. In a recent report, there was reduction in the risk of micro vascular complications including progression of nephropathy with intense glycemic control and sustaining the HbA1C level below 7%. In another meta-analysis of 7 clinical trials, intensive glycemic control plus use of an angiotensin converting enzyme inhibitor was associated with statistically significant reduction in the risk for microalbuminuria and macroalbuminuria. On the other hand, cases of nodular glomerulosclerosis and advanced diabetic nephropathy in the presence of well controlled diabetes mellitus, and cases of long term, poorly controlled diabetes lacking development of diabetic nephropathy, suggest there are factors other than the level of hyperglycemia which are important in influencing development of the renal disease. Progression of diabetic nephropathy (DN) to end stage renal disease (ESRD) can arise in the presence of minimal evidence for type 2 diabetes mellitus, and the recent literature indicates the pathology of diabetic nephropathy occurs even in the absence of diabetes, suggesting other contributors and potential mechanism for the pathology , such as increased glomerular mesangial GLUT1. In addition, Hepatitis C virus infection has been proposed in the literature as a possible accelerator for progression of diabetic nephropathy. Here we report a case of well controlled type 2 diabetes mellitus per definition by the level of HbA1C, with apparent rapid decline of renal function and concomitant Hepatitis C.
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