Successful immunosuppressive therapy in a patient with autoantibodies to insulin receptors and immune complex glomerulonephritis.

Altered mental status, acanthosis nigricans, immune complex glomerulonephritis with nephrotic syndrome, fasting hypoglycemia, and postprandial hyperglycemia associated with anti-insulin receptor antibodies (type B insulin resistance) developed in a 43-year-old black woman who initially was treated for diabetes mellitus. Her HLA phenotype was A2, A29, Bw45(w6), B13(w4), Cw3, DR1 (DQw1). Her serum contained immune complexes, low complement levels, and antibodies that bound to the glomerular mesangium of mouse kidney. All clinical and serologic abnormalities resolved with combination cyclophosphamide and glucocorticoid treatment, and low doses of these agents have maintained the remission for more than a year.