An Unusual Case of Nephrotic Syndrome and Glucosuria

Kwok, Sophie; D’Agati, Vivette D.; Anis, Kisra; Jim, Belinda

doi:10.1053/j.ajkd.2011.10.055

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…Kidney biopsies in long-term smokers, generally performed for proteinuria and renal insufficiency, have mostly reported nodular mesangial glomerulosclerosis in the absence of diabetes or other superimposed glomerular immune complex disease or other lesions [1,2,3,4,5,6]. The term ‘ING' (idiopathic nodular glomerulosclerosis) was first coined by Herzenberg et al to describe the glomerular morphology resembling nodular diabetic nephropathy (DN) (with expanded mesangial matrix, glomerular and tubular basement membrane thickening, vascular hyalinosis), but without clinical evidence of impaired glucose metabolism.…”

Section: Introductionmentioning

confidence: 99%

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Smoking-Related Glomerulopathy: Expanding the Morphologic Spectrum

Salvatore

Troxell

Hecox³

et al. 2015

Am J Nephrol

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Background: Chronic smoking and hypertension may lead to smoking-related nodular glomerulopathy (SRNG), a well-recognized entity that clinically and pathologically mimics nodular diabetic nephropathy (DN). However, like DN, diffuse mesangial sclerosis may occur in this setting without nodules. Methods: The clinicopathologic features of 10 non-diabetic patients with a long smoking history diagnosed from 2003-2012 showing diffuse mesangial glomerulosclerosis (6) or SRNG (4) were analyzed. Results: Nine of 10 patients were men, aged 58-80 with a 20-58 pack-year smoking history. None of the patients manifested diabetes, but all of them had hypertension. Numerous other cardiovascular comorbidities were present. At biopsy, the mean creatinine was 1.9 mg/dl (range 1.4-3) and the mean proteinuria was 3.9 g/24 h. The renal pathologic findings were similar in all patients except mesangial nodules in SRNG. Global glomerulosclerosis was seen in 6-72% of glomeruli (mean 31%), glomerulomegaly in all cases, and a range of interstitial fibrosis in 10-70% (mean 43%). Moderate (40%) and severe (50%) arteriosclerosis and arteriolar hyalinosis (80%) were also observed. Glomerular hilar or mesangial neovascularization was prominent. Endothelial swelling, subendothelial widening, and new basement membrane formation suggesting chronic healing thrombotic microangiopathy (TMA) was noted in 80%. No immune complexes were localized. Conclusions: Kidney biopsies from patients with proteinuria and chronic renal insufficiency in the setting of prolonged smoking and hypertension show either diffuse or nodular mesangial glomerulosclerosis. Chronic glomerular mesangial and endothelial injury associated with smoking leads to a chronic TMA appearance in the appropriate setting, even in the absence of mesangial nodule formation.

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Section: Introductionmentioning

confidence: 99%

“…In smoking-related glomerulopathy (SRG), lesions resembling chronic thrombotic microangiopathy (TMA) were specifically described by Liang et al, but TMA is also noted in the pathologic descriptions of nearly all reports of ING [1,2,3,4,7]. It is well known that endothelial injury is central in the development of TMA.…”

Section: Introductionmentioning

confidence: 99%

Smoking-Related Glomerulopathy: Expanding the Morphologic Spectrum

Salvatore

Troxell

Hecox³

et al. 2015

Am J Nephrol

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“…Additionally, they confirmed higher levels of IFTA and worst renal outcomes in patients with glycosuria 2,4 . Some investigations suggest that tubulointerstitial lesions may correlate better with outcomes in PG than glomerular damage itself 10,11 . They hypothesize that this glomerular-tubular relationship, that might be mediated by albuminuria, could be bidirectional.…”

Section: Discussionmentioning

confidence: 99%

“…The most widely accepted is that there is an association between the amount of filtered proteins and the degree of tubular damage 13 . After being filtered, proteins (including albumin) are reabsorbed in the proximal tubules by endocytosis, mainly in S1 segment 9,10,12,14 . Reubi et al (1984) 8 performed glucose titration experiments in 20 nephrotic patients and found that patients that present glycosuria show impaired kinetics of the proximal tubules 8 .…”

Section: Discussionmentioning

confidence: 99%

Glycosuria in primary glomerulopathies: prevalence and prognostic significance

et al. 2022

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Introduction: Tubular damage is common in glomerular diseases (GD). Glycosuria is a marker of tubular dysfunction and may be used to detect tubular lesion and CKD progression. The aim of this study was to evaluate the prevalence and prognostic value of glycosuria at the time of diagnosis in primary glomerulopathies (PG). Methods: We conducted a 24-month retrospective study in patients diagnosed with PG in our center between 2009 and 2020. We excluded diabetic patients, use of SGLT2 inhibitors, transplant patients, and secondary GD. Patients were divided in two groups according to their glycosuria status at diagnosis. Results: We studied 115 patients. Global prevalence of glycosuria was 10% (n=11) and membranous nephropathy (MN) had the highest prevalence (n=5, 17.9%). We found that patients with glycosuria had higher serum creatinine (2.4 vs. 1.2 mg/dL, p=0.030), higher albuminuria (4.8 vs. 1.9 g/g, p=0.004), and lower serum albumin (2.3 vs. 3.2 g/dL, p=0.021). We did not find association with histological prognostic factors. At the end of follow-up, patients with glycosuria had higher prevalence of the composite outcome of stage 5D CKD or 50% increase in basal SCr (45.5% vs. 17.3%, p=0.037). In patients with MN, results were similar but we were able to find an association of glycosuria with more severe interstitial fibrosis and tubular atrophy (25.0 vs. 0.0 %, p=0.032). Conclusion: Ten percent of our patients with PG have glycosuria. Glycosuria at the time of diagnosis was associated with more severe clinical presentation and worst renal outcome. The association with higher albuminuria suggests that tubular function has an impact on the severity and outcomes of PG.

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“…Pauci-immune crescentic glomerulonephritis (immune complexes are absent or minimal) is characteristic of ANCA-related glomerulonephritis. However, little or no immune complex deposition can also be seen in some infection-related glomerulonephritides, including legionella, visceral abscess, and other infections [54–58] Nodular glomerulosclerosis, the hallmark of diabetic glomerulopathy, can result from conditions as disparate as chronic thrombotic microangiopathy and cigarette smoking [59]. …”

Section: Introductionmentioning

confidence: 99%

Differential Diagnosis of Glomerular Disease: A Systematic and Inclusive Approach

Hebert¹,

Parikh²,

Prosek³

et al. 2013

Am J Nephrol

3,134

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Background: Glomerular disease is a complex and evolving topic. In evaluating a specific case it is not unusual for the clinician to ask: ‘Am I missing something? Should I biopsy? When? Should I treat first, then biopsy?' This work, which is both evidence and experience based, is intended to address each of these concerns and many other issues relevant to the differential diagnosis of glomerular disease. Summary: The central approach is the use of diagnostic algorithms that are based on quantitative measures routinely obtained early in the course of the diagnostic evaluation. The algorithms are designed to be easy to navigate, systematic, and inclusive. Also provided is a detailed and prioritized list of recommended diagnostic testing, and the rationale for each test. Key Message: This work is intended to facilitate accurate diagnosis in the individual patient presenting with evidence of glomerular disease.

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An Unusual Case of Nephrotic Syndrome and Glucosuria

Cited by 5 publications

References 9 publications

Smoking-Related Glomerulopathy: Expanding the Morphologic Spectrum

Smoking-Related Glomerulopathy: Expanding the Morphologic Spectrum

Glycosuria in primary glomerulopathies: prevalence and prognostic significance

Differential Diagnosis of Glomerular Disease: A Systematic and Inclusive Approach

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