Characteristic Renal Histology of a 81-Year-Old Patient with a 30-Year History of Diabetes Mellitus: A Case Report

Shima, Natsuki; Sawa, Naoki; Yamanouchi, Masayuki; Mizuno, Hiroki; Kawada, Manabu; Sekine, Akinari; Hiramatsu, Rikako; Hayami, Noriko; Hasegawa, Eiko; Suwabe, Tatsuya; Hoshino, Junichi; Takaichi, Kenmei; Ohashi, Kenichi; Fujii, Takeshi; Ubara, Yoshifumi

doi:10.1007/s13730-020-00483-9

Cited by 4 publications

(2 citation statements)

References 11 publications

(16 reference statements)

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“…2G). This finding has been reported as a type of vascular lesion in patients with diabetic nephropathy and has been considered to be associated with VEGF-related proliferation and elongation of efferent arterioles and hyperglycemia-related angiogenesis (19). Anti-VEGF agents similar to lenvatinib might contribute to polar vasculosis via pathogenetic mechanisms similar to diabetic nephropathy.…”

Section: Podocyte Foot Process Effacement (Black Arrows) Was Focal An...mentioning

confidence: 66%

Thrombotic Microangiopathy, Podocytopathy, and Damage to the Renal Tubules with Severe Proteinuria and Acute Renal Dysfunction Induced by Lenvatinib

et al. 2022

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Lenvatinib, a tyrosine kinase inhibitor (TKI), is a stronger inhibitor of vascular endothelial growth factor receptor, fibroblast growth factor receptors 1 to 4, and platelet-derived growth factor receptor (PDGFR) than other TKIs. We herein report a 77-year-old Japanese woman who received the minimum dose of lenvatinib for treatment of hepatocellular carcinoma. Within one month of starting treatment, she developed severe proteinuria, hypertension, and renal dysfunction. A kidney biopsy showed drug-induced thrombotic microangiopathy, podocytopathy, and polar vasculosis. We also observed damage to the renal tubules, where PDGFR is located. To our knowledge, this is the first report of lenvatinib-induced damage to the renal tubules.

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Section: Podocyte Foot Process Effacement (Black Arrows) Was Focal An...mentioning

confidence: 66%

Thrombotic Microangiopathy, Podocytopathy, and Damage to the Renal Tubules with Severe Proteinuria and Acute Renal Dysfunction Induced by Lenvatinib

et al. 2022

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“…In our patient, we noted arteriolar hyalinosis and polar vasculosis around the glomeruli. These arteriolar lesions have been reported to be one of the arteriolar lesions specific to patients with diabetes (9).…”

Section: Discussionmentioning

confidence: 83%

Nodular-like glomerular lesion after long-standing chronic renal infection in a patient with medullary sponge kidney and mild hyperglycemia

Nakashima

Kawada

Sekine

et al. 2022

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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A 63-year-old Japanese woman was admitted to our institute for the evaluation of proteinuria. The patient was diagnosed with medullary sponge kidney, distal type renal tubular acidosis, and renal infection at the age of 37. Thereafter, the patient had repeated renal infections. Urinary proteinuria appeared at around the age of 61 and gradually increased up to 1.0 g daily. In the same period, glycated hemoglobin (HbA1c) increased to 7.0%. On kidney biopsy, light microscopy showed a nodular glomerular lesion and capsular drop. Linear staining for immunoglobulin G along the glomerular basement membrane was observed by immunofluorescence. Electron microscopy showed thickening of the glomerular basement membrane to a width of 800–900 nm. A class III glomerular lesion was diagnosed according to the Tervaert classification. This case indicates that mild but prolonged hyperglycemia for more than 10 years may also contribute to the formation of nodular lesions, although long-standing repeated chronic renal infection and chronic acidosis may have been a precipitating factor in the formation of diabetic nephropathy, including nodular glomerular lesions. This hypothesis is of interest because nodular lesions specific to diabetes are currently considered to be associated with long-term severe hyperglycemia. Learning points Nodular glomerular lesions in diabetes mellitus are thought to be associated with long-term severe hyperglycemia. This case shows that although mild, long-term hyperglycemia for more than 10 years may also contribute to the formation of nodular lesions and that repeated chronic kidney infections over the years and chronic acidosis may be facilitating factors in the formation of diabetic nephropathy, including nodular glomerular lesions. This case appears to be idiopathic nodular glomerulosclerosis of the medullary sponge kidney associated with chronic urinary tract infection.

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An optimized diabetes mellitus detection model for improved prediction of accuracy and clinical decision-making

Althobaiti,

Selim

2024

Alexandria Engineering Journal

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Characteristic Renal Histology of a 81-Year-Old Patient with a 30-Year History of Diabetes Mellitus: A Case Report

Cited by 4 publications

References 11 publications

Thrombotic Microangiopathy, Podocytopathy, and Damage to the Renal Tubules with Severe Proteinuria and Acute Renal Dysfunction Induced by Lenvatinib

Thrombotic Microangiopathy, Podocytopathy, and Damage to the Renal Tubules with Severe Proteinuria and Acute Renal Dysfunction Induced by Lenvatinib

Nodular-like glomerular lesion after long-standing chronic renal infection in a patient with medullary sponge kidney and mild hyperglycemia

An optimized diabetes mellitus detection model for improved prediction of accuracy and clinical decision-making

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