Glomerulosclerosis.

Abstract

We present a case with the histologic features of diabetic glomerulopathy (DG) without the history of diabetes mellitus. A 67-year-old lady with history of alcohol abuse, active smoking, chronic anemia (myelodysplastic syndrome [MDS]) with multiple blood transfusions, and siderotic liver disease was admitted with worsening edema. She had BMI 24, positive anasarca, hemoglobin 8.5 gm/dl, serum creatinine 1.51 mg/dl, glucose 81 mg/dl with HBA1c 4.7%, serum albumin <2 gm/dl with urine protein/creatinine ratio 185 mg/gm, ANA positive 1:1280, positive anti CCP antibody, negative hepatitis B/C, low C3 and no monoclonal protein detected on SPEP/UPEP. Kidney biopsy revealed mesangial sclerosis, expansion with thickened basement membrane (BM) and nodular hyalinization of arterioles on light microscopy, and linear staining of IgG, IgA, light chains but negative complements on IF microscopy, and extensive thickening of BM (average 1000 nm), effaced foot process but no electron dense deposits on EM. She had positive siderosis and negative Congo red staining on liver biopsy, and negative amyloid on myocardial scan. In the past, she had episodes of hyperglycemia during acute illnesses such as sepsis, otherwise her fasting blood glucose remained mostly under 100 mg/dl and HBA1c between 4.3 to 5.1%. The histologic findings of our case are more compatible with diffuse glomerulosclerosis (GS) type of DG than nodular glomerulosclerosis (NG) type which is less often seen in DG. Diabetic GS-like, especially nodular GS-like lesion