Original ContributionsIdiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking*
Section snippets
Materials and methods
All native renal biopsy specimens (n = 5,073) accessioned in the Renal Pathology Laboratory at Columbia Presbyterian Medical Center from January 1996 to March 2001 were reviewed retrospectively for the presence of ING. ING was defined by (1) the absence of clinical evidence of DM; (2) the histological finding of nodular mesangial sclerosis; and (3) the exclusion by immunofluorescence and electron microscopy of chronic membranoproliferative glomerulonephritis, chronic thrombotic microangiopathy,
Results
The cohort of patients with ING had a mean age of 68.2 years (range, 47 to 80) and consisted of predominantly white (73.9%) and men (78.3%) (Table 1).Twenty-two of the 23 patients had a history of hypertension for a mean duration of 15.1 years. Twenty-one of the 23 patients (91.3%) had a history of smoking with a mean cumulative intake of 52.9 pack-years. This included 12 patients who were active smokers at the time of biopsy and 9 with a long-standing but remote history of tobacco use. A
Discussion
ING is a clinicopathologic entity that is by definition a diagnosis of exclusion. We report 23 cases of ING in which all previously defined entities that can produce nodular glomerulosclerosis were excluded. By analyzing the clinical and biopsy profile of this cohort, we identified common features that define ING as a distinct clinicopathologic entity. Patients with ING are typically older white men with a history of long-standing hypertension and smoking who present with renal insufficiency
References (24)
- et al.
Idiopathic nodular glomerulosclerosis
Am J Kidney Dis
(1999) - et al.
Obesity-related glomerulopathy (ORG): An emerging epidemic
Kidney Int
(2001) - et al.
The nephrotic syndrome, lipids, and risk factors for cardiovascular disease
Am J Kidney Dis
(1993) - et al.
Smoking is a risk factor for end-stage renal failure in men with primary renal disease
Kidney Int
(1998) - et al.
Systemic and pulmonary oxidative stress in idiopathic pulmonary fibrosis
Free Radic Biol Med
(1999) - et al.
Idiopathic lobular glomerulonephritis (nodular mesangial sclerosis): A distinct diagnostic entity
Clin Nephrol
(1989) Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
Diabetes Care
(1997)- et al.
The expression of advanced glycation end products and their cellular receptor RAGE in diabetic nephropathy and non-diabetic renal disease
J Am Soc Nephrol
(2000) - et al.
Blood pressure and end-stage renal disease in men
N Engl J Med
(1996) Diabetes and gout
Tobacco Use Among U.S. Racial/Ethnic Minority Groups-African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General
Cigarette smoking increases the risk of albuminuria among subjects with type I diabetes
JAMA
Cited by (100)
α1-Heavy Chain Deposition Disease With Negative Immunofluorescence Staining on Renal Biopsy
2019, Kidney International ReportsImpaired glucose metabolism – A potential risk factor for idiopathic nodular glomerulosclerosis: A single center study
2018, Medical HypothesesCitation Excerpt :Our case series is unique as the majority of our patients are non-white individuals with relatively insignificant tobacco smoking history. This contrasts with the two biggest case series reported by Columbia University (1996–2001) [14], where most patients were old, white, heavy-smoking males and the University of Texas/Houston (1998–2007) [13] where most patients were females. This gender distribution in the two biggest case series could be due to the sampling period with smoking becoming more prevalent among females over the last decades.
Factors leading to the discard of deceased donor kidneys in the United States
2018, Kidney InternationalChronic Kidney Disease
2018, Integrative Medicine: Fourth Edition“Diabetic nephropathy” in a non-diabetic patient
2016, Pathology Research and PracticeAn autopsy study suggests that diabetic nephropathy is underdiagnosed
2016, Kidney InternationalCitation Excerpt :Therefore, one should be cautious in extrapolating these results to other populations. Nodular lesions similar to those seen in class III DN may occur in patients with hypertension and a history of smoking but without diabetes (typically elderly men).29 It seems unlikely that our results were influenced by this entity, because only 2 patients in the underdiagnosed group were smokers and they did not have hypertension.
- *
Address correspondence and reprint requests to Vivette D. D'Agati, MD, Columbia University, College of Physicians and Surgeons, Department of Pathology, Renal Pathology Laboratory, 630 W 168th St, VC 14-224, New York, NY 10032.