This 57-year-old white male with a 25-year history of Type I 1 diabetes mellitus (insulin-dependent ) developed an acute myocardial infarction followed by cerebral infarction, pulmonary dysfunction, and renal failure. There was a history of hypertension , proteinuria, and proteinuria. Laboratory findings included a elevations in BUN and creatinine of 69 mg/dL and 3.3 mg/dL which subsequently rose to 113 and 4.8, respectively. He subsequently died of multisystem failure.

== Autopsy Findings ==The autopsy showed the expected concentric left ventricular hypertrophy, a large an acute myocardial infarction, and a large right cerebral infarction. The pancreas showed amyloidosis of the islets. There was extensive atherosclerosis and arteriolosclerosis. The kidneys were slightly enlargedlarge, weighing 220 and 240 grams respectively, and had a rough surfacessurface, a few cortical scars, and blurring of the corticomedullary junctions.

File:IPLab5DM2IPLab5DM2b.jpg|This is a low-power photomicrograph of the kidney from this patient. The section extends from cortex (1) to the medulla (2). File:IPLab5DM3IPLab5DM3b.jpg|This is a higher-power photomicrograph of the cortical region. In this region there is ischemic obsolescence of glomeruli and one glomerulus with nodular glomerulosclerosis (1). Also note the thickened walls of the blood vessels (2). File:IPLab5DM4IPLab5DM4b.jpg|This is a high-power photomicrograph of two glomeruli with intercapillary glomerulosclerosis (arrows). File:IPLab5DM5IPLab5DM5b.jpg|This is a photomicrograph of a glomerulus with nodular glomerulosclerosis (1). Also note the intertubular fibrosis and the changes in the blood vessels (2). File:IPLab5DM6IPLab5DM6b.jpgJPG|This is a higher-power photomicrograph of a glomerulus with nodular glomerulosclerosis (arrows). These are the classic Kimmelstiel-Wilson lesions ("K-W lesions") seen in diabetics with nodular glomerulosclerosis. File:IPLab5DM7IPLab5DM7b.jpg|This is a photomicrograph of kidney with a focal exudative lesion in a glomerulus (arrow) and sclerosis, interstitial fibrosis, and congestion.