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Kidney non-tumor

Associated with systemic conditions

Diabetic glomerulosclerosis


Reviewers: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 21 February 2014, last major update September 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● 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
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● 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/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
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● Five patients with acute post-staphylococcal glomerulonephritis complicating diabetic nephropathy, with IgA deposition in glomeruli (Hum Pathol 2003;34:1235)
● Insudative hyaline cap lesions (Hum Pathol 1989;20:388)

Micro description
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● 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 (pathogenesis of Kimmelstiel-Wilson nodule))
● Profound hyalinization of afferent arterioles (insudative lesion-intramural): specific for diabetes in afferent arterioles, but non-specific if in periphery of glomerular loop, Bowmanís 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)

Micro images
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Various images


Arteriolar hyalinosis PAS stain


Diffuse and nodular sclerosis PAS


Nodular sclerosis PAS


Nodular sclerosis Trichrome

Immunofluorescence
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● Diffuse linear staining for IgG along capillary walls
● Also IgM, IgA and albumin (considered to be non-specific trapping of plasma proteins due to basement membrane or mesangial dysfunction)

Electron microscopy description
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● Diffuse thickening of basement membranes; increased mesangial matrix

Electron microscopy images
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Thick glomerular capillary basement membrane, uniform and homogenous


Thick GBM

Differential diagnosis
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Amyloidosis
Cryoglobulinemia
Fibrillary glomerulonephritis
Immunotactoid glomerulonephritis

End of Kidney non-tumor > Associated with systemic conditions > Diabetic glomerulosclerosis

Ref Updated: 7/24/12


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