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Clinical History:
67
year old female with long standing and uncontrolled
diabetes mellitus, now with nephrotic range proteinuria
(5.5 g/ 24 hr) and actively rising creatinine (6.6 mg/
dL).
Histology:
The glomeruli show severe, diffuse glomerulosclerosis
with mesangial expansion and many nodular lesions. Some
glomeruli show capillary aneurysms and others show focal
segmental glomerulosclerosis changes with foam cells.
The interstitial space shows moderate expansion with
extensive tubular atrophy and moderate fibrosis and
chronic inflammation. PAS staining confirms the presence
of PAS positive deposits in the mesangial spaces, some
with nodular appearance and thickening of the basement
membrane of capillary loops and tubules. The trichrome
stain in Figure D shows nodular sclerosis and
interstitial fibrosis. The glomerular basement membrane
thickening and nodular mesangial expansion is shown by
Jones silver stain in figure E.
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