Korean J Nephrol.  2005 Mar;24(2):313-319.

A Case of Idiopathic Nodular Glomerulosclerosis Presenting Rapid Progressive Renal Failure

• Hur SE
• Kim HW
• Shim BY
• Wie SH
• Choi JR
• Shin MJ
• Shin YS
• Park CW
• Choi YJ
• Chang YS
• Bang BK

Abstract

Idiopathic nodular glomerulosclerosis is an unusual entity with histopathologic features resembling nodular diabetic glomerulosclerosis but occurs in non diabetic patients and predominantly in older males with smoking and long standing hypertension. It is characterized histologically by nodular mesangial sclerosis, glomerular basement membrane thickening, and arteriolosclerosis in the absence of immune-type deposit, and clinical presentations typically include renal insufficiency and severe proteinuria with relatively poor prognosis. We experienced a rare case of idiopathic nodular glomerulosclerosis presenting rapid progressive renal failure in a 42-year-old man without clinical evidence of diabetes. He was admitted with peripheral edema and renal insufficiency. He had a history of hypertension for 2 years and chronic hepatitis B for 5 years. Funduscopy and renal ultrasound were normal. HbA1c and oral glucose tolerance test were normal and on serum and urine electrophoresis, M-spike was not found. Light microscopic examination demonstrated the characteristic features of lobular glomerulonephritis showing glomerular hypertrophy and nodular mesangial sclerosis. Immunofluorescence was negative for immune-type deposits. Electron microscopy showed marked increase of mesangial matrix, mesangial cell proliferation, moderate effacement of foot processes, and glomerular basement thickening without electron-dense deposits or other specific fibrils. Idiopathic nodular glomerulosclerosis was diagnosed. After discharge, he continued smoking and his blood pressure was not controlled. Three months after first biopsy, second biopsy was performed because of increasement of serum creatinine and specimens showed progression of tubulointerstitial change and nodular mesangial sclerosis. Subsequent serum creatinine was progressively increased and hemodialysis was started 13 months after diagnosis.

Keyword

Idiopathic nodular glomerulosclerosis; Renal failure; Smoking; Hypertension

MeSH Terms

Adult
Arteriolosclerosis
Biopsy
Blood Pressure
Creatinine
Diabetic Nephropathies*
Diagnosis
Edema
Electrophoresis
Fluorescent Antibody Technique
Foot
Glomerular Basement Membrane
Glomerulonephritis
Glucose Tolerance Test
Hepatitis B, Chronic
Humans
Hypertension
Hypertrophy
Male
Mesangial Cells
Microscopy, Electron
Prognosis
Proteinuria
Renal Dialysis
Renal Insufficiency*
Sclerosis
Smoke
Smoking
Ultrasonography
Creatinine
Smoke