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Nodular glomerulosclerosis in a patient with metabolic syndrome without diabetes

Abstract

Background A 56-year-old man with previously treated hepatitis C presented to a nephrology clinic with hypertension, proteinuria and declining renal function. His medical history included previous smoking, prior hip replacements with prolonged osteomyelitis, and left renal artery stenosis. Diabetes mellitus was ruled out by a 2 h oral glucose tolerance test and two glycated hemoglobin (HbA1c) measurements. A renal biopsy showed evidence of nodular glomerulosclerosis.

Investigations Physical examination, renal biopsy, and urine and blood analyses including an oral glucose tolerance test.

Diagnosis Nodular glomerulosclerosis and metabolic syndrome.

Management Patients with metabolic syndrome should be screened for evidence of renal injury since clinical and histological nodular glomerulosclerosis identical to diabetic nephropathy can occur in this setting. Early diagnosis and treatment of albuminuria could alter the course of disease progression.

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Figure 1: Light microscopy image of a glomerulus with nodular increase in mesangial matrix material and early microaneurysm formation.
Figure 2: Electron micrographs of glomerular capillaries.

References

  1. Grundy SM et al. (2004) Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 109: 433–438

    Article  Google Scholar 

  2. Genuth S et al. (2003) Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 26: 3160–3167

    Article  Google Scholar 

  3. Kusaba T et al. (2007) Idiopathic nodular glomerulosclerosis: three Japanese cases and review of the literature. Clin Nephrol 67: 32–37

    CAS  Article  Google Scholar 

  4. Herzenberg AM et al. (1999) Idiopathic nodular glomerulosclerosis. Am J Kidney Dis 34: 560–564

    CAS  Article  Google Scholar 

  5. Navaneethan SD et al. (2005) Nodular glomerulosclerosis in a non-diabetic patient: case report and review of the literature. J Nephrol 18: 613–615

    PubMed  Google Scholar 

  6. Markowitz GS et al. (2002) Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking. Hum Pathol 33: 826–835

    Article  Google Scholar 

  7. Westall GP et al. (2004) Nodular glomerulosclerosis in cystic fibrosis mimics diabetic nephropathy. Nephron Clin Pract 96: c67–c69

    Article  Google Scholar 

  8. Jensen R and Larsen VS (1990) Nodular mesangial glomerulosclerosis in patients without manifest diabetes mellitus. Int Urol Nephrol 22: 95–103

    CAS  Article  Google Scholar 

  9. Nash DA et al. (1975) Diabetic glomerulosclerosis without glucose intolerance. Am J Med 59: 191–199

    Article  Google Scholar 

  10. Altiparmak MR et al. (2002) Diffuse diabetic glomerulosclerosis in a patient with impaired glucose tolerance: report on a patient who later develops diabetes mellitus. Neth J Med 60: 260–262

    CAS  PubMed  Google Scholar 

  11. Macrae J et al. (1990) Diabetic nephropathy without hyperglycemia. J Diabet Complications 4: 126–131

    CAS  Article  Google Scholar 

  12. Expert panel on the detection, evaluation, and treatment of high blood cholesterol in adults (2001) Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert panel on the detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285: 2486–2497

  13. Alberti KG et al. (2005) The metabolic syndrome—a new worldwide definition. Lancet 366: 1059–1062

    Article  Google Scholar 

  14. Schelling JR and Sedor JR (2004) The metabolic syndrome as a risk factor for chronic kidney disease: more than a fat chance? J Am Soc Nephrol 15: 2773–2774

    Article  Google Scholar 

  15. Bagby SP (2004) Obesity-initiated metabolic syndrome and the kidney: a recipe for chronic kidney disease? J Am Soc Nephrol 15: 2775–2791

    Article  Google Scholar 

  16. Cusumano AM et al. (2002) Glomerular hypertrophy is associated with hyperinsulinemia and precedes overt diabetes in aging rhesus monkeys. Am J Kidney Dis 40: 1075–1085

    Article  Google Scholar 

  17. Chen J et al. (2004) The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med 140: 167–174

    Article  Google Scholar 

  18. Stevens LA et al. (2006) Surrogate end points for clinical trials of kidney disease progression. Clin J Am Soc Nephrol 1: 874–884

    Article  Google Scholar 

  19. Garber AJ (2004) The metabolic syndrome. Med Clin North Am 88: 837–846

    CAS  Article  Google Scholar 

Download references

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Correspondence to Sharon G Adler.

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Souraty, P., Nast, C., Mehrotra, R. et al. Nodular glomerulosclerosis in a patient with metabolic syndrome without diabetes. Nat Rev Nephrol 4, 639–642 (2008). https://doi.org/10.1038/ncpneph0946

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