Tubulointerstitial Nephritis Complicated with Primary Sjögren’s Syndrome under Treatment for Type 2 Diabetes Mellitus

Shinichi Antoku, Hiroyuki Ito, Mizuo Mifune, Hiroko Nawata, Masahiro Kato

Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Tokyo, Japan.
Department of Internal Medicine, Edogawa Hospital, Tokyo, Japan.
Department of Neurology, Edogawa Hospital, Tokyo, Japan.

DOI: 10.4236/ojneph.2012.24017                

Abstract

Tubulointerstitial nephritis complicated by primary Sj?gren’s syndrome in a patient under treatment for type 2 diabetes mellitus was diagnosed in the early stage of the disease by renal biopsy. The symptoms of primary Sj?gren’s syndrome, such as thirst and polydipsia, were masked by the characteristic symptoms of type 2 diabetes mellitus. An association between sicca symptoms and diabetes mellitus (types 1 and 2) has been previously reported. Hence, it is possible that there are common underlying immunological mechanisms between primary Sj?gren’s syndrome and diabetes mellitus of both types. Intervention with steroids in a timely manner appears to have prevented or slowed the progression of re- nal impairment.

Keywords

Tubulointerstitial Nephritis; Sjögren’s Syndrome; Type 2 Diabetes Mellitus

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	T. Fujibayashi, S. Sugai, N. Miyasaka, Y. Hayashi and K. Tsubota, “Revised Japanese Criteria for Sj?gren’s Syndrome (1999): Availability and Validity,” Modern Rheumatology, Vol. 14, No. 6, 2004, pp. 425-434. doi:10.1007/s10165-004-0338-x
[2]	K. Asmussen, V. Andersen, G. Bendixen, M. Schi?dt and P. Oxholm, “A New Model for Classification of Disease Manifestations in Primary Sj?gren’s Syndrome: Evaluation in a Retrospective Long-Term Study,” Journal of Internal Medicine, Vol. 239, No. 6, 1996, pp. 467-474. doi:10.1046/j.1365-2796.1996.418817000.x
[3]	W. H. Tu, M. A. Shearn, J. C. Lee and J. Hopper Jr, “Interstitial Nephritis in Sj?gren’s Syndrome,” Annals of Internal Medicine, Vol. 69, No. 6, 1968, pp. 1163-1170.
[4]	H. M. Moutsopoulos, J. E. Balow, T. J. Lawley, N. I. Stahl, T. T. Antonovych and T. M, Chused, “Immune Complex Glomerulonephritis in Sicca Syndrome,” The American Journal of Medicine, Vol. 64, No. 6, 1978, pp. 955- 960. doi:10.1016/0002-9343(78)90449-7
[5]	M. Pertovaara, M. Korpela and A. Pasternack, “Factors Predictive of Renal Involvement in Patients with Primary Sj?gren’s Syndrome,” Clinical Nephrology, Vol. 56, No. 1, 2001, pp. 10-18.
[6]	N. Bossini, S. Savoldi, F. Franceschini, et al., “Clinical and Morphological Features of Kidney Involvement in Primary Sj?gren’s Syndrome,” Nephrology Dialysis Trans- plantation, Vol. 16, No. 12, 2001, pp. 2328-2336. doi:10.1093/ndt/16.12.2328
[7]	S. Masouridi, A. G. Tzioufas, J. P. Ioannidis, F. N. Skopouli and H. M. Moutsopoulos, “Clinically Significant and Biopsy-Documented Renal Involvement in Primary Sj?gren’s Syndrome,” Medicine (Baltimore), Vol. 79, No. 4, 2000, pp. 241-249. doi:10.1097/00005792-200007000-00005
[8]	S. Kubo, K. Hiroshige, A. Osajima, M. Takasugi and A. Kuroiwa, “Autopsy Findings of Primary Sj?gren’s Syndrome with End-Stage Renal Failure,” Nephron, Vol. 65, No. 3, 1993, p. 485. doi:10.1159/000187542
[9]	T. Ikai T, Y. Kanezaki, T. Shimada, et al., “Slowly Pro- gressive Type I Diabetes Seen in a Case with Polyglandular Autoimmune Syndrome Complicated by Sj?gren’s Syndrome and Chronic Thyroiditis,” Tokushima Red cross Hospital Medical Journal, Vol. 13, No. 2008, pp. 37-42, (in Japanese, abstract in English).
[10]	O. Kinoshita, K. Kubo and S. Kusama, “A Case of Insulin Resistant Diabetes Mellitus Due to Insulin-Receptor Autoantibodies with Sj?gren’s Syndrome,” Nippon Naika Gakkai Zasshi (The Journal of The Japanese Society of Internal Medicine), Vol. 77, No. 10, 1988, pp. 1572-1575, (in Japanese). doi:10.2169/naika.77.1572
[11]	B. Pal, “Sj?gren’s Syndrome and Diabetes Mellitus,” Br J Rheumatology, Vol. 29, No. 2, 1990, pp. 157-158. doi:10.1093/rheumatology/29.2.157
[12]	A. Binder, P. J. Maddison, P. Skinner, A. Kurtz and D. A. Isenberg, “Sj?gren’s Syndrome: Association with Type-1 Diabetes Mellitus,” British Journal of Rheumatology, Vol. 28, No. 6, 1989, pp. 518-520. doi:10.1093/rheumatology/28.6.518