Kidney biopsy findings in diabetic nephropathy
What are the findings seen on kidney biopsy in diabetic nephropathy?
Three classic features seen on kidney biopsy:
1. Mesangial expansion leading to wide-appearing glomeruli
2. Thickening of the glomerular basement membrane (GBM) with the notable absence of GBM deposits
3. Nodular glomerulosclerosis. Nodular glomerulosclerosis typically presents as rounded tufts of acellular matrix in the mesangium. These are called Kimmelstiel-Wilson nodules.
Other findings include hyaline deposition within Bowman capsule and the afferent and efferent arterioles.
This arteriolar deposition can distinguish DN from hypertensive nephropathy, in which hyalinosis is limited to the afferent arteriole.
Although nodular glomerulosclerosis is typically found in diabetic patients, it can also be seen in monoclonal immunoglobulin deposition disease, amyloidosis, membranoproliferative glomerulonephritis, and in idiopathic nodular sclerosis, a disease of older Caucasian patients with history of hypertension and tobacco use.
