Idiopathic nodular glomerulosclerosis: a case report

• Author(s): Cunha,Catia ; Gomes,Ana Marta ; Lopes,Daniela ; Sousa,Sonia ; Pereira,Susana ; Campelos,Sofia ; Tente,David ; Fernandes,Joao Carlos
• Date: 2015
• Origin: SciELO Portugal
• Subject(s): Hypertension; nodular glomerulosclerosis; smoking
• Document Type: Report
• Language: English

Description

The histological pattern of nodular glomerulosclerosis is typical of diabetic nephropathy, but it can be found in other diseases, such as chronic membranoproliferative glomerulonephritis, amyloidosis, monoclonal immunoglobulin deposition and fibrillary/immunotactoid glomerulopathies. Additionally, there are few reports of idiopathic nodular glomerulosclerosis, an exclusion diagnosis, which has been associated with smoking. Herein we present a case of a non-diabetic 45-year-old man, with a background history of hypertension known for 5 years and heavy smoking, who was referred to our Nephrology clinic for evaluation of haematoproteinuria. Renal function was normal and serologies and immunoelectrophoresis studies were negative. Renal biopsy revealed a nodular glomerulosclerosis pattern on light microscopy, and immunofluorescence and electronic microscopy excluded other previously referred causes for this pattern. By exclusion, a diagnosis of idiopathicnodular glomerulosclerosis was established, probably in association with smoking and hypertension. Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity that should be considered in patients with active smoking, especially if there is concomitant hypertension. Some authors actually suggest the designation of “smoking -related nodular glomerulosclerosis” to this “pseudodiabetic” glomerulopathy.