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Clinical History: Morbidly obese 55 year old male with
nephrotic range proteinuria and a long standing history
of poorly controlled Diabetes Mellitus type 1. He also
has mild to moderate hypertension
Histology: Figures
A, B, C show moderate to severe glomerulosclerosis
with mesangial expansion, capillary aneurysms and
nodular lesion also called Kimmelstiel-Wilson nodule (
pointed by arrow in Figure C). The interstitial space
shows moderate to severe expansion with focal atrophy of
some tubules, fibrosis and chronic inflammation. PAS
staining ( Figures A, B, C, D) confirms the presence of
PAS positive nodular deposits in the mesangial spaces.
There is also thickening of the Bowman's
capsule, as well as thickening of the basement membrane
of capillary loops, tubules and arterioles.
Electron micrographs
(Figure D and E)
show
basement membranes thickening at the lamina densa and
extensive mesangial matrix accumulation. There is also
widespread foot process effacement
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