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Nodular glomerulosclerosis in a patient with metabolic syndrome without diabetes


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.


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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).

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