Diabetic Glomerulosclerosis, Nodular and Diffuse
Feature
Disease Facts
Synonyms
Kimmelstiel-Wilson disease.
Epidemiology
Common cause of renal failure in patients with diabetic patients. Occurs in 30-50% patients with juvenile-onset diabetes mellitus. Increases in incidence with duration and severity of adult-onset diabetes mellitus, usually after 20 years.
Pathogenesis
Renal disease secondary to microangiopathy of diabetes, with thickening of basement membranes. Related to severity of disease process.
Clinical
Presentation
Proteinuria is major manifestation, nephrotic syndrome may develop. Hypertension and microscopic hematuria later develop.
Laboratory
Features
Proteinuria ± hematuria. Elevated glucose, BUN, creatinine. Increased renal size, renal blood flow and GFR early in course.r
Anatomic
Pathology

Gross Small contracted kidneys with granular surface.
LM Glomerular disease may be diffuse, nodular, or mixed (most patients)

Diffuse diabetic glomerulosclerosis: Increased mesangial matrix, thickened basement membranes, hyaline arteriosclerosis of afferent and efferent arterioles.

Nodular diabetic glomerulosclerosis: Hyaline nodules (Kimmelstiel-Wilson lesions) prominent.

Acute/chronic pyelonephritis and arteriolonephrosclerosis often present in both forms.

IF Nonspecific.
EM Marked generalized thickening of glomerular basement membrane, mesangial nodules.
Clinical
Course
and Prognosis
Renal pathologic changes are generally irreversible but speed of progression related to clinical control of hyperglycemia. Chronic glomerulosclerosis and end-stage renal disease is eventual outocme if diabetes not controlled.
Treatment
Control of hyperglycemia. Dialysis or renal transplantation in end-stage cases.
References
and
Web Links
General References

UConn http://radiology.uchc.edu/TMGEN/71200028.htm
UConn PathWeb http://radiology.uchc.edu/eAtlas/GU/1527.htm
HealthCentral http://www.healthcentral.com/mhc/top/000494.cfm

Images

UPMC http://www.omed.pitt.edu/MS-II/BODY-FLUID/RENAL/PBL/CASE4/index.html
UConn http://pathology.uchc.edu/lectures/Renal.html
W.B. Saunders
(Robbins)
http://pathcuric1.swmed.edu/PathDemo/end6/tofc.htm
Tulane Univ. http://www.mcl.tulane.edu/classware/pathology/McPath/GR_Renal/Renal8.html