Normoglycaemia in acute renal failure--a difficult diagnosis of diabetes

We report diagnostic difficulties in a case of diabetes mellitus presenting as acute on chronic renal failure with normoglycaemia. A renal biopsy indicated diabetic nephropathy; she developed hyperglycaemia following the institution of haemodialysis. It is important to remember that diabetic patients may have normal blood glucose concentrations in renal failure. In a patient with undiagnosed diabetes mellitus presenting with acute on chronic renal failure, choice of diagnostic biochemical test for diabetes may be difficult.