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Currently filtering by tag: Nodular glomerulosclerosis

Smoking-Related Glomerulopathy

A renal biopsy was performed on this 52-year-old male with a history of hypertension and heavy tobacco use, who is being worked up for nephrotic range proteinuria and increased creatinine. The glomeruli (Fig 1 and 2) show nodular mesangial matrix expansion without definitive proliferation, necrosis or crescents. Focal areas of segmental glomerulosclerosis are present. There is no evidence of immune complex or monoclonal immunoglobulin deposition by immunofluorescence or electron microscopy. Of note, electron microscopy does show global thickening of glomerular basement membranes (not shown). While non-specific, the most common cause of nodular glomerulosclerosis in the United States is diabetes mellitus/glucose...

Diagnose This! (March 5, 2018)

What is the most likely diagnosis? For bonus points, what is the basic differential for this morphologic finding (non-immune and immune)?     ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​...

Diabetic Nephropathy

Protein Insudative Lesions in Diabetic Glomerulopathy Diffuse and nodular glomerulosclerosis is the classic appearance of diabetic glomerulopathy. However, diabetic nephropathy also includes so-called insudative lesions including “Fibrin Caps” and “Capsular Drops”. These lesions are characteristically seen in diabetics with nephrotic range proteinuria and are thought to be the result of ‘insudation’ of protein and other serum products into the space between the cell lining and its supporting basement membrane. In the case of the Fibrin Cap, the lesion is seen between the endothelium and the glomerular basement membrane (Blue Arrows, Jones Silver 400x). Fibrin cap is a misnomer because there...

FSGS Tip Lesion – Secondary

The patient is a 64-year-old male with a history of diabetes mellitus, hypertension, and hyperlipidemia, who presents with an increased creatinine of 1.8 mg/dl and proteinuria (UPCR 2.5 g/g). Serologic workup is completely negative. A renal biopsy was performed and shows nodular glomerulosclerosis (Fig 1) and arteriolar hyalinosis characteristic of diabetic glomerulopathy. Additionally, the glomeruli focally show areas of segmental glomerulosclerosis associated with endocapillary foam cells. These lesions are located at the take-off point of the proximal tubule (Fig 1) and reminiscent of the glomerular lesions seen in the tip variant of FSGS. Electron microscopy shows mesangial matrix expansion, mostly...

IgG Background Staining in Diabetic Nephropathy

Immunofluorescence staining with IgG in a patient with diabetic nephropathy shows enhanced linear staining along the glomerular basement membranes and all other basement membranes. This includes the tubules and Bowman’s capsule. It also highlights the mesangial nodules. This is non-specific and not to be confused with anti-glomerular basement membrane antibody disease (anti-GBM, also called Goodpasture Syndrome). Diabetic staining is 1+ to 2+ and distributed along all basement membranes. If anti-GBM is also present in diabetic nephropathy, the IgG will be 3+ along the GBMs and the other basement membranes will have the background 1+ to 2+ staining. Sometimes this is...

Diffuse and Nodular Glomerulosclerosis in Diabetic Glomerulopathy

Diffuse and nodular glomerulosclerosis is the classic appearance of diabetic glomerulopathy. Note the variability in mesangial areas in this one glomerulus. Some show only mesangial matrix increase while others demonstrate nodule formation. This section is stained with silver methenamine Masson Trichrome (SMMT). With this stain, the mesangium is black indicating that it is all matrix increase with no immune complex type deposits and no infiltrative processes such as amyloid or the fibrils of fibrillary glomerulopathy among others. (SMMT 400x)