The Syndrome of Hyperglycaemia without Glycosuria - An Overview
A. S. V. Prasad *
Formerly, Department of Internal Medicine, GITAM Dental College, G. I. T. A. M University Campus, Rishikonda, Visakhapatnam, India.
*Author to whom correspondence should be addressed.
Abstract
The importance of hyperglycaemia without glycosuria, seems to have been under played, as evidenced by the paucity of reports about the same, in the literature. Ralph H. Major et al. [1] observed in JAMA, on review of literature till then, that there was no reported case as such, in the literature before. CF. Davidson et al. [2] reported in the Journal of Endocrinology, that between 1932 t0 1937 inclusive, not even a single case of hyperglycaemia without glycosuria was reported in the literature. Hardly there are not even a handful of cases reported till this date, as observed by this author. The awareness appears to be low, as regards to the significance of this syndrome. With the dispensing off, of urine glucose testing, consequent to the advent of home monitoring of the blood sugar with glucometer, there is a every chance of missing this entity. The complacency, that this is just as sequel to the increased renal threshold /tubular maximum that occurs in the natural history of long standing DM2, could also be contributory for not taking this syndrome seriously. This fatalistic attitude, might under score the underlying structural and functional damage of the kidneys. This article aims to shift the emphasis to renal glomerular than tubular pathology, leading to the syndrome of hyperglycaemia without glycosuria.DM2, being the leading cause of the end stage renal disease (ESRD),focus on this syndrome is expected to create awareness among the patients of DM2,about the underlying serious structural and functional damage, to their kidneys. This syndrome is hoped to serve as a biomarker of DKD (diabetic kidney disease) progressing to ESRD, which helps the diabetic patient to seek nephrologist's consultation/ intervention earlier than otherwise. It could serve as a prelude for ordering other tests like estimated glomerular filtration rate (eGFR) and protein –creatinine (PCR) ratio etc. The necessary pathophysiological basis is provided for proper understanding of this syndrome along with review of literature and emphasis on its importance in the early recognition and prevention of ESRD, are focussed in this article.
Keywords: Diabetic nephropathy, KW syndrome, glomerular nodulosclerosis, renal threshold, transport maximum, end stage renal disease, glycosuria.