Dr G.B. Piccoli Chair of Nephrology University of Turin Turin, Italy

 

In July 2004, a 35 year old Caucasian woman came to the Diabetologist, asking for advice, as she had recently got married and wanted to have a baby. She had just moved from another location to our city, and wished to plan a diabetic care follow-up in her new environment.

She had had type 1 diabetes diagnosed at the age of twenty, and had been followed somewhat irregularly in a different setting. Over time, she had developed several end organ damages (retinopathy, neuropathy and kidney disease); while retinopathy had been laser treated, a work-up for kidney involvement had never been performed, despite the presence of macroalbuminuria at urinary dipstick tests.

At the first updating in the Diabetic Care Unit in the new setting, kidney involvement was staged as severe, on the basis of the presence of nephrotic proteinuria and of the decrease of kidney function, with reduced renal clearances (Creatinine clearance about 50 mL/min). She was normotensive and had never taken any hypotensive or anti-proteinuric drug.

Figure 1

Piero della Francesca: Madonna del Parto. 1467 Detached fresco; 206 x 203 cm. Santa Maria a Nomentana, Monterchi

This well known fresco by Piero della Francesca depicts, with a rather unusual symbology, a pregnant Madonna. On her side, two angels with mirroring gestures and complementary colours. While the pregnant Madonna symbolises the Church itself, this wonderful fresco, presumably painted after the death of the artist's mother, the gentle and thoughtful figure of the young Madonna is often considered as a true “icon” of the sacred value of pregnancy.

 

Question 1