Article Text

Download PDFPDF
Diabetic nephropathy and end-stage renal disease in a 28-year-old woman, or is it?
  1. Zainab Mahmood1 and
  2. Jayne A Barr2
  1. 1Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
  2. 2Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
  1. Correspondence to Ms Zainab Mahmood; zainab.mahmood{at}


A 28-year-old Hispanic woman presented to the emergency department with pneumonia and bilateral pulmonary oedema, requiring admission to the intensive care unit. Additional history included type 1 diabetes mellitus, End Stage Renal Disease on haemodialysis and Hashimoto’s disease. On further diagnostic evaluation, she was found to have systemic lupus erythematosus (SLE) with overlap syndrome. The goal of this case report was twofold: to share our holistic investigative processes and to explore how racial identity and experiences play a role in health disparities present in SLE. The diagnostic process was difficult because of language and socioeconomic barriers our patient experienced. Additionally, SLE in the Hispanic population has only recently been researched, limiting specifics about presentation and disease course. In the Hispanic population, SLE has increased morbidity and mortality when compared with the Caucasian population. Thus, our patient’s case highlights the need for holistic practices when diagnosing patients, particularly in historically and presently marginalised identities.

  • ethnic studies
  • renal medicine
  • systemic lupus erythematosus
  • sociology

Statistics from


  • Contributors ZM was a medical student and JAB was the attending physician on the patient’s care team, participating in the diagnostic process. The discussion to share this case was between them and the patient towards the end of her hospital admission. ZM wrote the case report with support and supervision from JAB. They have both participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript. Both ZM and JAB have given the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.