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Currently filtering by tag: Smoking-related glomerulopathy

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...


This glomerulus is large! Glomerular enlargement, or glomerulomegaly, may be diagnosed when a glomerulus sectioned through the hilum fills greater than 50% of a 40x microscopic field. It is thought to be a morphologic marker of glomerular hyperfiltration. While not specific, glomerulomegaly is often seen in patients with obesity-related glomerulopathy, in which case there is often the additional finding of focal segmental glomerulosclerosis. More recently, Salvatore and colleagues found glomerulomegaly in association with either diffuse mesangial or nodular glomerulosclerosis in all patients with chronic renal insufficiency and proteinuria who had a prolonged history of smoking and hypertension (see reference). Salvatore...