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Rethinking Glycemic Thresholds: Diabetic Kidney Disease in the Absence of Overt Diabetes
Nirmay Sonar1, Jarvis Pennington2, Mishell Siles Borda1
1Internal Medicine, Norton Community Hospital, Norton, USA.
European Journal of Case Reports in Internal Medicine
|August 11, 2025
Summary
Diabetic kidney disease may develop even without diabetes or pre-diabetes. Current diagnostic methods using hemoglobin A1c may miss at-risk individuals, suggesting stricter glycaemic thresholds are needed.
Area of Science:
- Nephrology
- Endocrinology
- Diabetology
Background:
- Diabetic kidney disease (DKD) is typically linked to chronic hyperglycemia in diabetes.
- The direct correlation between glycemic thresholds and DKD development is under scrutiny.
- A case challenges the traditional understanding of DKD etiology.
Purpose of the Study:
- To present a case of DKD in a patient without diabetes or pre-diabetes.
- To question the sufficiency of current diagnostic markers like hemoglobin A1c.
- To explore the possibility of DKD developing in normoglycemic individuals.
Main Methods:
- Case report of a 69-year-old woman with progressive renal dysfunction.
- Renal biopsy findings suggestive of diabetic kidney disease.
- Repeatedly normal glycosylated hemoglobin (hemoglobin A1c) levels.
Main Results:
- The patient exhibited biopsy-confirmed diabetic kidney disease.
- Despite normal hemoglobin A1c, renal dysfunction progressed.
- The case demonstrates DKD occurrence without overt hyperglycemia or diabetes diagnosis.
Conclusions:
- Diabetic kidney disease can manifest in individuals without diabetes or pre-diabetes.
- Hemoglobin A1c alone may be an inadequate screening tool for DKD.
- Stricter glycemic criteria may be necessary for early identification and prevention of renal complications.
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