March 16, 2021
Diagnose This (March 15, 2021)

- Published: March 16, 2021
- By: Joel Murphy, MD
- Tags: Class III, idiopathic nodular glomerulosclerosis, Nodular Diabetic Glomerulopathy, Type II Diabetes
What is your diagnosis in a patient (non-smoker) with worsening proteinuria and a negative immunofluorescence panel?
Answer: The light microscopic image of a PAS-stain demonstrates severe, nodular glomerulosclerosis compatible with nodular diabetic glomerulopathy, RPS class III. Clinically, the patient carried a diagnosis of type II diabetes for >10 years with a recent hemoglobin A1c of 12%. Of note, in the absence of diabetes, nodular glomerulosclerosis can also be seen in what is known as idiopathic nodular glomerulosclerosis, thought to be secondary to hypertension and/or smoking (see references). While light chain deposition disease can also lead to a nodular sclerosis pattern of injury, the immunofluorescence panel was negative in this case and no deposits were present by electron microscopy.
References:
Markowitz GS, Lin J, et al. Idiopathic Nodular Glomerulosclerosis is a Distinct Clinical Pathologic Entity Linked to Hypertension and Smoking. Human Pathology 2002 August; 33 (a): 826-35.
Nasr S, D’Agati V. Nodular Glomerulosclerosis in the Non-diabetic Smoker. J Am Soc Nephrol 2007; 18: 2032-2036.