Kidney nontumor
Glomerular disease
Diabetic renal disease
Diabetic renal disease

Topic Completed: 3 February 2014

Minor changes: 27 July 2020

Copyright: 2002-2020,, Inc.

PubMed Search: Diabetic glomerulosclerosis [title] kidney pathology

Nikhil Sangle, M.D.
Page views in 2019: 10,629
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Cite this page: Sangle N. Diabetic renal disease. website. Accessed August 12th, 2020.
Definition / general
  • Diffuse capillary basement membrane thickening, diffuse and nodular glomerulosclerosis
  • Causes glomerular disease, arteriolar sclerosis, pyelonephritis, papillary necrosis; similar between type I and II patients
  • Accounts for 30% of long term dialysis patients in US; causes 20% of deaths in patients with diabetes < age 40
  • Changes may be related to nephronectin, which functions in the assembly of extracellular matrix (Nephrol Dial Transplant 2012;27:1889)
Clinical features
  • Proteinuria occurs in 50%, usually 12 - 22 years after onset of diabetes
  • End stage renal disease occurs in 30% of type I patients
  • Early increased GFR and microalbuminemia (30 - 300 mg per day) are predictive of future diabetic nephropathy
  • Renal disease reduced by tight diabetic control; may recur with renal allografts; ACE inhibitors may reduce progression
Case reports
Microscopic (histologic) description
  • Basement membrane thickening and increased mesangial matrix in ALL patients
  • Diffuse glomerulosclerosis: increase in mesangial matrix associated with PAS+ basement membrane thickening, eventually obliterates mesangial cells
  • Nodular glomerulosclerosis: also called intercapillary glomerulosclerosis or Kimmelstiel-Wilson disease; ovoid, spherical, laminated hyaline masses in peripheral of glomerulus, PAS+, eventually obliterates glomerular tuft; specific for diabetes and membranoproliferative glomerulonephritis, light chain disease and amyloidosis (Hum Pathol 1993;24:77)
  • Profound hyalinization of afferent arterioles (insudative lesion - intramural): specific for diabetes in afferent arterioles, but nonspecific if in periphery of glomerular loop, Bowman’s capsule or mesangium; insudative material composed of proteins, lipids and mucopolysaccharides
  • Organizing fibroepithelial crescents: associated with aggressive clinical course
  • Diffuse thickening of tubular basement membrane, tubular atrophy and interstitial fibrosis
  • Isolated thickened glomerular basement membrane and proteinuria may be an early predictor of diabetic disease (Mod Pathol 2004;17:1506)
Microscopic (histologic) images

Images hosted on PathOut server:

Arteriolar hyalinosis PAS stain

Diffuse and nodular sclerosis PAS

Nodular sclerosis PAS

Nodular sclerosis trichrome

Images hosted on other servers:

Various images

Immunofluorescence description
  • Diffuse linear staining for IgG along capillary walls
  • Also IgM, IgA and albumin (considered to be nonspecific trapping of plasma proteins due to basement membrane or mesangial dysfunction)
Electron microscopy description
  • Diffuse thickening of basement membranes; increased mesangial matrix
Electron microscopy images

Images hosted on PathOut server:

Thick GBM

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