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Lupus Nephritis and Other Autoimmune Features in Patients with Diabetes Mellitus Due to Autoantibody to Insulin Receptors

GEORGE C. TSOKOS, M.D.; PHILLIP GORDEN, M.D.; TATIANA ANTONOVYCH, M.D.; CURTIS B. WILSON, M.D.; and JAMES E. BALOW, M.D.
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Grant support: in part by grants AM-20043, AI-07007, and AM-32353 from the U. S. Public Health Service; and Biomedical Research Support Grant RRO-5514.

▸Requests for reprints should be addressed to George C. Tsokos, M.D.; National Institutes of Health, Building 10, Room 3N114; Bethesda, MD 20205.


Bethesda, Maryland; Washington, D.C.; and La Jolla, California


Ann Intern Med. 1985;102(2):176-181. doi:10.7326/0003-4819-102-2-176
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The frequency of various autoimmune features in 14 patients with insulin-resistant diabetes mellitus (type B) was reviewed. Twelve patients had leukopenia, high titers of antinuclear antibodies (speckled pattern), and hypoalbuminemia; 11 had elevated serum levels of IgG and high erythrocyte sedimentation rates; 7 had proteinuria and high serum levels of antibodies to DNA; and 5 had alopecia and elevated serum levels of IgA. Lupus erythematosus preparations were negative in all patients. Eight patients met the conventional criteria for the diagnosis of systemic lupus erythematosus. Three patients developed renal involvement while under care at the National Institutes of Health. Kidney tissue samples showed proliferative and membranous glomerulonephritis, tubulointerstitial nephritis, and electron-dense deposits similar to those of lupus nephritis. The lupus nephritis in these 3 patients appeared to be independent of the level of insulin-receptor antibody and glucose dysmetabolism. This study documents the presence of systemic lupus erythematosus in a large proportion of patients with insulin resistance due to autoantibodies to insulin receptors and emphasizes that careful monitoring of such patients for major complications of lupus nephritis is warranted.

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