Renal Failure as the Initial Manifestation of Diabetes Mellitus

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Abstract
Renal failure due to intercapillary glomerulosclerosis (Kimmelstiel-Wilson lesion) is a frequent cause of death among patients with diabetes mellitus and is virtually always preceded by clinical symptoms of glucose intolerance for several years. Rarely, however, intercapillary glomerulosclerosis has been detected in patients with renal failure without a history of preceding glucose intolerance.1,2 The purpose of this report is to describe two patients without symptomatic glucose intolerance in whom severe renal insufficiency due to "diabetic kidney disease" was the initial manifestation of their disease. Patient Summaries Patient 1. —A 42-year-old man was referred to University Hospital in June 1970 for evaluation of severe azotemia detected during investigation of increasing fatigue, dyspnea, nausea, and vomiting. There was no known personal or family history of diabetes mellitus and he specifically denied polydypsia, polyuria, history or symptoms of urinary tract infection, and blurred vision. He had not seen a physician during the preceding

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