IPLab:Lab 5:Nodular Intercapillary Glomerulosclerosis
This 57-year-old white male with a 25-year history of Type I diabetes mellitus (insulin-dependent ) developed an acute myocardial infarctionMyocardial infarction is necrosis of myocardial tissue which occurs as a result of a deprivation of blood supply, and thus oxygen, to the heart tissue. Blockage of blood supply to the myocardium is caused by occlusion of a coronary artery. followed by cerebral infarction, pulmonary dysfunction, and renal failureRenal failure is the severe reduction of renal function and often leads to reduced urinary output.. There was a history of hypertension and proteinuriaProtein in the urine is indicative of glomerular dysfunction.. Laboratory findings included a BUN and creatinineThese tests are measures of kidney function. High levels mean low function. of 69 mg/dLA normal BUN for this patient would be 10 to 20 mg/dL. and 3.3 mg/dLThe normal creatinine level is 0.7 to 1.3 mg/dL. which subsequently rose to 113 and 4.8, respectively. He subsequently died of multisystem failure.
The autopsy showed the expected left ventricular hypertrophy, a large acute myocardial infarctionMyocardial infarction is necrosis of myocardial tissue which occurs as a result of a deprivation of blood supply, and thus oxygen, to the heart tissue. Blockage of blood supply to the myocardium is caused by occlusion of a coronary artery., and a large right cerebral infarction. The pancreas showed amyloidosis of the islets. There was extensive atherosclerosis and arteriolosclerosis. The kidneys were slightly enlarged, weighing 220 and 240 gramsA normal kidney weighs 157 grams (range: 115 to 220 grams). respectively, and had rough surfaces, a few cortical scars, and blurring of the corticomedullary junctions.
The Kimmelstiel-Wilson (K-W) lesions are ovoid or spherical, often laminated, hyaline masses situated in the periphery of the glomerulus. They are usually within the mesangium of the glomeruli. The nodules are composed of lipids and fibrin. As the disease progresses the K-W nodules enlarge until they compress and obliterate the glomerular tuft. Because of these glomerular and arteriolar lesions, the blood flow to the kidney is compromised and the kidney becomes ischemic. This results in tubular atrophy and interstitial fibrosis and leads to a roughened renal cortical surface.
Approximately 15-30% of long term diabetics develop K-W lesions and in most instances it is associated with renal failureRenal failure is the severe reduction of renal function and often leads to reduced urinary output..
- eMedicine Medical Library: Type 1 Diabetes Mellitus
- eMedicine Medical Library: Type 2 Diabetes Mellitus
- Merck Manual: Diabetes Mellitus (DM)
- Herzenberg AM, Holden JK, Singh S, Magil AB. Idiopathic nodular glomerulosclerosis. Am J Kidney Dis 1999 Sep;34(3):560-4.
- Vinik AI. Diabetic Sensory and Motor Neuropathy. N Engl J Med" 2016 April 14; 374:1455-1464.
- Kamel KS and Halperin ML. Acid–Base Problems in Diabetic Ketoacidosis. N Engl J Med" 2015 Feb 5;372:546-554.
- PEIR Digital Library: Diabetic Glomerulosclerosis Images
- WebPath: Interstitial Diseases of the Kidney
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